Tuberculous Meningitis After Intrathecally Administered Methylprednisolone Acetate

THE INTRATHECAL USE of methylprednisolone acetate in the treatment of sciatica and arachnitis was introduced in 1961 by Gardner and associates.1In reporting 3 1/2 years of experience with the intrathecal use of methylprednisolone acetate, Sehgal and Gardner2noted the complete absence of serious complications. More recently, Shealy3described the case of a patient with sciatic pain, treated with methylprednisolone acetate given intrathecally, in whomCryptococcus neoformansmeningitis later developed. He emphasized the need for careful evaluation of patients before the intrathecal use of drugs. During the past 14 months, 53 patients on the neurosurgical service have been treated with methylprednisolone acetate given intrathecally for low back and lower-extremity pain after myelography. Tuberculous meningitis subsequently developed in one of the patients. The relationship between the use of systemic steroids and the development and dissemination of pulmonary tuberculosis has been known for some time. The appearance of tuberculous