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Canadian Journal of Gastroenterology
Volume 9 (1995), Issue 2, Pages 81-84
http://dx.doi.org/10.1155/1995/641296
Brief Communication – Hepatology

Unusual Infections Complicating the Use of Steroids with Severe Alcoholic Hepatitis: Report of 2 Cases

Vitor Arantes,1 Pina Michieletti,2 Ross Cameron,2 Jenny Heathcote,2 and Morris Sherman2

1Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
2Departments of Medicine and Pathology, Faculty of Medicine, University of Toronto and the Toronto Hospital, Toronto, Ontario, Canada

Received 21 April 1994; Accepted 28 October 1994

Copyright © 1995 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Corticosteroid therapy for acute alcoholic hepatitis has been demonstrated to enhance survival in patients who are encephalopathic, and who do not have renal failure or gastrointestinal bleeding. However, the complications of steroid therapy in such patients have been less well documented. The authors report two patients with alcoholic liver disease who developed life-threatening infections after steroid therapy was started. The first patient initially developed diabetes followed by Fournier's gangrene of the perineum, and a lung abscess following septic emboli. The second patient had established alcoholic cirrhosis rather than alcoholic hepatitis. She developed a necrotic ulcer on the arm at the site of an intravenous line, which was infected with a rhizopus species. Despite surgical debridement the lesion progressed and contributed to her death. Treatment of alcoholic hepatitis with steroids is not innocuous, and physicians should be aware of the potential for life-threatening complications.