A possible role for corticosteroids in the treatment of influenzal pneumonia.
A 52-year-old woman with severe influenzal pneumonia developed increasing hypoxaemia on the sixth and seventh hospital days. Hydrocortisone (250 mg intravenously) was given on the seventh day and the arterial oxygen tension increased within two hours. Clinical improvement continued with further steroid therapy. Corticosteroids were ceased after three weeks, but were recommenced three weeks later when the vital capacity (VC) remained about half of the expected normal value. Although the VC had not altered for two weeks, the reintroduction of a steroid was followed within a week by an increase in VC which continued for a further eight weeks. Sequential measurements of the mechanical properties of the lungs during this recovery period showed that atelectatic areas had reinflated. Instability of lung units accompanied the increase in lung volume, suggesting a partial deficiency of surfactant in the recruited units. Eighteen months after presentation, lung volumes remained mildly decreased but the elastic behaviour, airway conductance, and gas exchanging properties of the lungs were normal. Although some alveoli had been permanently lost, there was no evidence of diffuse lung fibrosis and the remaining lung units functioned normally.
D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D000860:Hypoxia / Q000188:drug therapy / Q000209:etiology; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use*
D011241:Prednisone; D006854:Hydrocortisone