Whipple's Disease (Intestinal Lipodystrophy) and Serum Glycoproteins

Abstract

after intradermal injection of cortisone. The oral administration of 100 mg. of cortisone daily for six weeks produced unequivocal regression of skin lesions in the four patients so treated. The degree of improvement was comparable to that produced in iso¬ lated lesions by single, local injections of 2.5 mg. of hydrocortisone. Improvement seemed to occur more slowly with orally administered cortisone, and the lesions recurred more promptly when it was stopped.The response of skin lesions to local or oral steroid therapy was not related to the known duration of the lesions, i. e., lesions of long-standing responded equally as well as those that had been present for a short time.The development of new lesions in previously un¬ involved skin areas in three of four patients following oral therapy suggests that there was spread of the dis¬ ease process at the time of relapse. This phenomenon, which has been called "rebound relapse," has not been noted by previous authors reporting on the beneficial effects of systemic cortisone therapy in sarcoidosis; however, it has been described in patients with rheu¬ matoid arthritis 8 following cortisone therapy. SUMMARY AND CONCLUSIONSThe gross and histological effects of the local infiltra¬ tion of hydrocortisone and cortisone on the skin lesions of sarcoidosis have been studied in five patients. The local infiltration of hydrocortisone produced complete or nearly complete regression of all lesions injected. Partial relapse of most of the lesions occurred four to seven weeks after maximal response. The local infil¬ tration of cortisone produced less complete regression, and relapse occurred somewhat earlier. These agents, when injected locally, apparently produce their effects by a direct action on the pathological process of sarcoid¬ osis. No qualitative histological alterations attributable to the steroids were observed in the granulomatous reaction of sarcoidosis in skin lesions. Gross and micro¬ scopic observations suggested that the steroids persisted locally after intradermal injection. This was confirmed by chemical and Chromatographie analysis.After the evaluation of local injection, cortisone was given orally for six weeks to four patients. Cortisone given orally caused regression of cutaneous lesions that was comparable to that produced by the local injection of hydrocortisone; however, the onset of improvement was more gradual and recurrence was more prompt with systemic therapy. Spread of the dis¬ ease process ("rebound relapse") occurred in three of four patients after oral treatment with cortisone was stopped. The results of this study suggest that, in selected cases, the local administration of hydrocortisone may be useful in controlling the skin lesions of sarcoidosis.