Steroids: a promising drug for abdominal tuberculosis?

Sir,

I am grateful for the excellent contribution of Dasgupta A et al.[1] to the study of abdominal tuberculosis, but I would like to make one comment. The authors show that vasculitis is a major mechanism of disease in abdominal involvement of tuberculosis. It has been previously demonstrated that steroids added to the general anti-tuberculous regimen could decrease mortality in these patients.[2-3] In pericardial and meningeal involvement, steroids have demonstrated a better outcome, since vasculitis represents a pathogenic contribution to the injury caused by Mycobacterium tuberculosis. Adjunctive prednisolone in the treatment of effusive tuberculous pericarditis has proven efficacy in HIV patients with a reduction of death risk (relative risk 0.5)[2] Treatment with dexamethasone was associated with a reduced risk of death in tuberculous meningitis (relative risk, 0.69) although it was not associated with a significant reduction in the proportion of severe sequelae.[3]

These preliminary evidence should encourage starting randomized controlled trials to definitely support the use of steroids in abdominal tuberculosis. This novel approach could even help to decrease the need of surgery as perforation and bowel obstruction could be avoided.