Increasing dose of methylprednisolone pulse therapy treats desquamative interstitial pneumonia in a child

A 10 yr old male with hypoxaemia, progressive infiltration on the chest rad iograph and biopsy-proven desquamative interstitial pneumonia was treated w ith daily oral prednisolone for 6 months. Intravenous methylprednisolone pulses were concomitantly administered in do ses averaging 10 mg.kg body weight(-1) on three consecutive days every 4-6 weeks. After 6 months improvement could be noted and oral steroids were sto pped, while pulse therapy continued. Three months later, when seven pulses had been administered, a relapse occurred and the clinical status deteriora ted. Instead of reinstating daily systemic steroids, the dose of methylprednisol one pulses was increased to 20 mg.kg body weight(-1) i.v. given on three co nsecutive days and repeat pulses every 4 weeks. This was followed by contin uous improvement. After 24 months corticosteroid pulses were terminated. No rmal lung function, serum lactate dehydrogenase, blood gases upon exertion and regular development was achieved. During the course of treatment, the c hild has grown 10 cm. It is concluded that the effect of corticosteroid pulse therapy on intersti tial lung disease in childhood is dose-dependent and that the dose can be a djusted to the effect observed.