METHYL-PREDNISOLONE IN PULMONARY TUBERCULOSIS WITH DIABETES MELLITUS

to cortico-steroid therapy whensuchtreatment first becameavailable. Steroids havenow become standard adjuvant therapy totheusualantituberculous drugs inmostcasesoffulminant pulmonary tuberculosis andtheTuberculosis Society ofScotland report (I957, 1958) confirmed thevalueofsuchcombined treatment. Even smalldosesofcortico-steroids seemtohavea definite value asshownbyWeinstein andKohler ('959)- AttheDreadnought Seamen's Hospital, cases of advanced, bilateral orfulminant pulmonary tuberculosis arefrequently seen, moreespecially among Indian andPakistani seamen.Thereasons for this arenotpertinent tothepresent paperbut experience hassuggested thatpatients fromthe Indian sub-continent often haveapoorresponse to tuberculous infection whilst amongst theChinese thereverse seemstoobtain. Forthese reasons wefrequently haverecourse tocortico-steroids andonmorethanoneoccasion wehaveseen diabetes mellitus diagnosed onlyafter glycosuria hasoccurred, apparently asadirect result ofa gluco-corticoid action. Diabetes mellitus hasgenerally beenregarded ascontraindicating theuseofcortico-steroids in anybutthemostcompelling emergencies. Quite recently Oakley etal.(I959) haveshownthat in insulin resistant diabetes, duetoinsulin antibodies, steroids maycounteract whatis, perhaps, anauto-immune reaction andinthis wayovercome aninsulin resistance. Thepresent casepresents thecombination ofpulmonary tuberculosis with diabetes mellitus, bothproving resistant to standard treatment until steroids intheformof methyl-prednisolone