Eight patients having advanced filarial elephantiasis were treated with cortisone. Initial treatment consisted of 100 mgm. daily in divided doses, over a period of 30 days or longer. Dosage was then lowered stepwise over several days before discontinuance. Six patients had a marked response to treatment, with diuresis followed by reduction or disappearance of induration. One patient's response could not be assessed; his case was complicated by concurrent arteriosclerotic heart disease. The other treatment failure was in a patient with verrucous skin changes involving penis and scrotum. Such skin changes, which were also seen to a minor degree in other patients, were unaffected by cortisone.
In five of the six patients, although induration reappeared or increased following discontinuance of therapy, improvement persisted during the entire period of observation. This period varied from about seven to ten months. Retreatment with smaller doses of cortisone for short periods as relapse occurred seemed beneficial.
In the one patient with microfilaremia prior to treatment, the number of microfilariae in the circulating blood increased markedly during treatment, then diminished again as induration reappeared. Biopsies before and after treatment in one patient showed no effect on the elephantoid tissue itself. Diuresis and increase in microfilaremia suggest that the action of cortisone is to reduce the inflammatory blockage of the lymphatics.