Steroid therapy in glandular fever.

Glandular fever or infectious mononucleosis is a disease of undetermined aetiology which may present variously. The literature is replete with accounts of its complications. In spite of the usually benign course, there remains a small mortality rate and it is therefore not surprising that adrenal corticosteroid treatment has been used in the severest forms of the illness. Doran et al.3 described the use of ACTH in the anginose type of glandular fever, and Mandel6 reported a case of impending respiratory obstruction due to anginose glandular fever in which ACTH avoided the need for tracheotomy. A patient with Guillain-Barre syndrome in association with glandular fever was treated successfully with cortisone,4 and another with thrombocytopenia also responded to cortisone,5 though it should be mentioned that a platelet agglutinating factor was present in this patient. Finally the use of prednisone in the successful treatment of a severe anginose case has been described by Creditor et al.,2 and several patients were treated by Mason et al.7 for very short periods and with indeterminate results. The above and other reports suggest that steroids are effective in the treatment of this condition, and it is the purpose of this paper to consider the possible indications for such therapy, supported by short case histories in io patients. The diagnosis of glandular fever in our cases was made clinically, and by the presence of a Paul-Bunnell test positive in diagnostic titre after absorption by guinea-pig kidney,' and/or the presence of atypical lymphocytes in the peripheral blood.