Corticosteroid therapy for refractory infections in chronic granulomatous disease: case reports and review of the literature.
BACKGROUND
Chronic granulomatous disease (CGD) is a primary phagocyte immunodeficiency. It is often accompanied by an exuberant and aberrant inflammatory response, with granulomata and obstruction of the gastrointestinal and genitourinary tracts and inflammatory bowel disease. Although corticosteroids are successful in managing the obstructive and inflammatory disorders of CGD, they are not ordinarily used for the management of infection because of the possibility of further compromising the patient's immune system.


OBJECTIVE
To discuss the pros and cons of the use of corticosteroids for the treatment of infections in CGD.


METHODS
We describe 2 patients with CGD and refractory infections who were successfully treated with systemic corticosteroids in addition to antimicrobial agents. We also review the medical literature in which corticosteroids have been used for CGD infection.


RESULTS
Our cases add to 3 other reports in which antibiotics and corticosteroids were used successfully in patients with CGD. However, in the presence of a potential pathogen, notably, aspergilla, corticosteroids may mask or favor dissemination of the fungus, especially in adults.


CONCLUSIONS
Corticosteroids may play an important adjunctive role in CGD refractory infections.
Yamazaki-Nakashimada
Marco A
MA
Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico. yzki71@yahoo.com.mx
Stiehm
E Richard
ER
Pietropaolo-Cienfuegos
Dino
D
Hernandez-Bautista
Victor
V
Espinosa-Rosales
Francisco
F
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001996:Bronchopneumonia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008100:Liver Abscess / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011241:Prednisone / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D011241:Prednisone; D006854:Hydrocortisone