Acute and Critical Care

Review Article

Basic Science and Research
Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines: Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Bhupinder Singh, Rohit Jain; Acute Crit Care. 2024;39(3):331-340. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00647

54,829 View
2,918 Download
9 Web of Science
13 Crossref

Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.

Citations

Citations to this article as recorded by

Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
Xinlong Zhang, Kaizong Huang, Zixin Wu, Rui Ding, Junming Han, Yuan Zhang, Yaping Lu, Yingmei Lu, Yanna Si
Pharmacology & Therapeutics.2026; 278: 108971. CrossRef
Brain-Region-Mediated Neuroimmune Modulation in Sepsis: Research Advances and Therapeutic Prospects
Xuechun Zhou, Ying Tang, Hui Chen, Wei Huang, Haibo Qiu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients
Sophon Dumrongsukit, Suranut Charoensri, Kamonwan Mulalin, Anupol Panitchote
Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand
Auttawut Chalermwutanon, Sawangjit Saejaow, Veerapong Vattanavanit
Acute and Critical Care.2026; 41(1): 107. CrossRef
Neuroendocrine Balance Index: an Indicator of Metabolic Response to Surgical Stress in Cardiac Surgery
Lada O. Sobanska, Volodymyr I. Cherniy
Ukrainian Journal of Cardiovascular Surgery.2026; 34(1): 119. CrossRef
The cortisol stress response following surgery for proximal femur fractures in geriatric patients – a prospective pilot study
Maximilian M. Menger, Laura E. Streck, Benedikt J. Braun, Steven C. Herath, Christof K. Audretsch, Maximilian Bamberg, Michael D. Menger, Tina Histing, Johann Fontana
Frontiers in Endocrinology.2026;[Epub] CrossRef
Managing sepsis in the era of precision medicine: a narrative review
Ho Jin Yong, Sung Min Kim, Dohhyung Kim
Acute and Critical Care.2026; 41(2): 189. CrossRef
Physiological Influence of Licorice Extract on Some Hormonal and Biochemical Parameters Alterations Induced by Glucocorticoid in Male Rats
Sohier Syame, Safinaz Badie
Ricos Biology.2025; 3(2): 19. CrossRef
Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
Ashley N. Radig, Vanessa A. Curtis, Erik Westlund, Christina L. Cifra
Journal of Intensive Care Medicine.2025; 40(12): 1285. CrossRef
Recognizing and managing critical illness-related corticosteroid insufficiency in pediatric critical care
Ja Hye Kim
Archives of Pediatric Critical Care.2025; 3(1): 14. CrossRef
A consensus blood transcriptomic framework for sepsis
Brendon P. Scicluna, Kiki Cano-Gamez, Katie L. Burnham, Emma E. Davenport, Andrew Reese Moore, Soumen Khan, Charles J. Hinds, Olaf L. Cremer, Purvesh Khatri, Timothy E. Sweeney, Julian C. Knight, Tom van der Poll
Nature Medicine.2025; 31(12): 4119. CrossRef
Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a Middle Eastern Cohort
Fayez Alshamsi, Saeed Alkaabi, Maryam Nasser Mohamedali Alfadli, Naser Abdulla Naser Salem Alshkeili, Sultan Majed Ibrahim Alhosani, Adnan Agha
Diagnostics.2025; 15(20): 2588. CrossRef
Integration of the hypothalamic–pituitary–adrenal and hypothalamic–pituitary–thyroid axes in immunometabolic allostasis of the acute phase of inflammation: A unified cytokine-mediated regulatory complex
O.M. Biletska, Ye.V. Garyachiу, O.V. Markovska, S.I. Latohuz, A.S. Shevchenko
Medicine Today and Tomorrow.2025;[Epub] CrossRef

Original Article

Infection
Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study: Keum-Ju Choi, Soo Kyun Jung, Kyung Chan Kim, Eun Jin Kim; Acute Crit Care. 2023;38(1):57-67. Published online February 7, 2023; DOI: https://doi.org/10.4266/acc.2022.00941; Correction in: Acute Crit Care 2023;38(2):249

19,659 View
245 Download
5 Web of Science
5 Crossref

Abstract PDF

Background
The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods
This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results
Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions
Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.

Citations

Citations to this article as recorded by

The relationship between steroid treatment and mortality in patients with COVID-19 followed up in an intensive care unit
Huseyin Ali Ozturk, Fatih Necip Arici
PeerJ.2025; 13: e18606. CrossRef
Investigation of antibiotic resistance against pathogens isolated from respiratory samples in intensive care units after SARS-CoV-2 pandemic
Ayşe Çapar, Derya Özyiğitoğlu, Şeyma Başlılar
BMC Infectious Diseases.2025;[Epub] CrossRef
Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit
Francesco Ferro, Gaetano La Rocca, Elena Elefante, Nazzareno Italiano, Michele Moretti, Rosaria Talarico, Erika Pelati, Katia Valentini, Chiara Baldini, Roberto Mozzo, Luigi De Simone, Marta Mosca
International Journal of Molecular Sciences.2024; 25(13): 7273. CrossRef
Comparative Efficacy of Inhaled and Intravenous Corticosteroids in Managing COVID-19-Related Acute Respiratory Distress Syndrome
Ahmed A. Abdelkader, Bshra A. Alsfouk, Asmaa Saleh, Mohamed E. A. Abdelrahim, Haitham Saeed
Pharmaceutics.2024; 16(7): 952. CrossRef
Dosage and utilization of dexamethasone in the management of COVID-19: A critical review
Imran Sethi, Asim Shaikh, Musa Sethi, Hira Khalid Chohan, Sheraz Younus, Syed A Khan, Salim Surani
World Journal of Virology.2024;[Epub] CrossRef

Review Article

Meta-analysis
The efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis: Manoj Kumar Reddy Somagutta, Maria Kezia Lourdes Pormento, Muhammad Adnan Khan, Alaa Hamdan, Namrata Hange, Manish KC, Sukrut Pagad, Molly Sanjay Jain, Sivasthikka Lingarajah, Vishal Sharma, Jaspreet Kaur, Bernard Emuze, Erkan Batti, Obumneme Jude Iloeje; Acute Crit Care. 2021;36(3):185-200. Published online June 30, 2021; DOI: https://doi.org/10.4266/acc.2021.00108

22,212 View
519 Download
14 Web of Science
16 Crossref

Abstract PDF Supplementary Material

Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P=0.92; I²=0%); intensive care unit (ICU) mortality (RR, 0.77; P=0.20; I²=58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I² =37%) or hospital length of stay (WMD: 0.57; P=0.49; I²=17%), and renal replacement therapy (RR, 0.64; P=0.44; I²=39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, –0.72; P=0.01; I²=32%). However, a significant effect was noted for the duration of vasopressor use (WMD, –25.49; P<0.001; I²=46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

Citations

Citations to this article as recorded by

Essential minerals and risk of pancreatic diseases: a large-scale prospective cohort study
Pengwei Cao, Zhihua Shui, Xinyu Zhang, Endi Zhou, Tan Liang, Feng Cao, Chuang Yang, Daoxiang Zhang, Lei Liu, Jiangming Chen, Fubao Liu
Frontiers in Nutrition.2026;[Epub] CrossRef
The Interplay Between Nutrition and Microbiota and the Role of Probiotics and Symbiotics in Pediatric Infectious Diseases
María Slöcker-Barrio, Jesús López-Herce Cid, María José Solana-García
Nutrients.2025; 17(7): 1222. CrossRef
MiR-143-5p serves as a diagnostic biomarker in patients with sepsis and regulates sepsis-induced inflammation and cardiac dysfunction
Yaqi Wu, Le Gu, Xu Huang
Hereditas.2025;[Epub] CrossRef
Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis
Huoyan Liang, Qingqing Mu, Wenju Sun, Liming Liu, Simin Qiu, Zili Xu, Yuqing Cui, Yan Yan, Tongwen Sun
Frontiers in Nutrition.2023;[Epub] CrossRef
Insights Into Thiamine Supplementation in Patients With Septic Shock
Nara Aline Costa, Amanda Gomes Pereira, Clara Sandra Araujo Sugizaki, Nayane Maria Vieira, Leonardo Rufino Garcia, Sérgio Alberto Rupp de Paiva, Leonardo Antonio Mamede Zornoff, Paula Schmidt Azevedo, Bertha Furlan Polegato, Marcos Ferreira Minicucci
Frontiers in Medicine.2022;[Epub] CrossRef
Vitamin C-induced Hemolysis: Meta-summary and Review of Literature
Deven Juneja, Ravi Jain
Indian Journal of Critical Care Medicine.2022; 26(2): 224. CrossRef
Is it time to reconsider the administration of thiamine alone or in combination with vitamin C in critically ill patients? A meta-analysis of clinical trial studies
Nafiseh Shokri-mashhadi, Ali Aliyari, Zahra Hajhashemy, Saeed Saadat, Mohammad Hossein Rouhani
Journal of Intensive Care.2022;[Epub] CrossRef
Parenteral Vitamin C in Patients with Severe Infection: A Systematic Review
Arnav Agarwal, John Basmaji, Shannon M. Fernando, Fang Zhou Ge, Yingqi Xiao, Haseeb Faisal, Kimia Honarmand, Mathieu Hylands, Vincent Lau, Kimberley Lewis, Rachel Couban, François Lamontagne, Neill K. J. Adhikari
NEJM Evidence.2022;[Epub] CrossRef
Unanswered questions on the use of hydrocortisone, ascorbic acid, and thiamine therapy in sepsis and septic shock
David Ragoonanan, Nicolas Tran, Veeshal Modi, Paige Morgan Nickelsen
American Journal of Health-System Pharmacy.2022; 79(19): 1626. CrossRef
Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
The impact of vitamin C-containing treatment on the mortality of patients with sepsis: A systematic review and meta-analysis of randomized controlled trials
Ching-Yi Chen, Chien-Tung Chiu, Ho-Sheng Lee, Chih-Cheng Lai
Journal of Infection and Public Health.2022; 15(12): 1514. CrossRef
Role of high dose vitamin C in management of hospitalised COVID-19 patients: A minireview
Deven Juneja, Anish Gupta, Sahil Kataria, Omender Singh
World Journal of Virology.2022; 11(5): 300. CrossRef
Current role of high dose vitamin C in sepsis management: A concise review
Deven Juneja, Prashant Nasa, Ravi Jain
World Journal of Critical Care Medicine.2022; 11(6): 349. CrossRef
HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
Shock.2022; 58(5): 426. CrossRef
Early administration of Vitamin C in patients with sepsis or septic shock in emergency departments: A multicenter, double blinded, randomized controlled trial: The C-EASIE trial protocol
Stefanie Vandervelden, Lina Wauters, Jan Breuls, Steffen Fieuws, Philippe Vanhove, Ives Hubloue, Magali Bartiaux, Jacques Creteur, François Stifkens, Koen Monsieurs, Didier Desruelles, Elisa Panada
PLOS ONE.2021; 16(11): e0259699. CrossRef
Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis
Weilan Na, Huili Shen, Yichu Li, Dong Qu
Journal of Intensive Care.2021;[Epub] CrossRef

Original Articles

Basic Science and Research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness: Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):38-45. Published online January 30, 2019; DOI: https://doi.org/10.4266/acc.2018.00339

10,953 View
144 Download
5 Web of Science
5 Crossref

Abstract PDF Supplementary Material

Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

Citations

Citations to this article as recorded by

Some aspects of the humoral dysfunctions in patients with chronic disorders of consciousness (literature review)
P. Pradhan, M. V. Petrova, I. V. Borisov, A. M. Fisun, D. V. Protasova, L. M. Tsentsiper
Messenger of ANESTHESIOLOGY AND RESUSCITATION.2026; 23(2): 111. CrossRef
Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
Wen Xu, Yuzhen Qiu, Hongping Qiu, Ming Zhong, Lei Li
International Journal of General Medicine.2024; Volume 17: 127. CrossRef
PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
Shock.2023; 59(6): 871. CrossRef
Copeptin and stress-induced hyperglycemia in critically ill patients: A prospective study
Lilian Rodrigues Henrique, Daisy Crispim, Tarsila Vieceli, Ariell Freires Schaeffer, Priscila Bellaver, Cristiane Bauermann Leitão, Tatiana Helena Rech, Antonio Palazón-Bru
PLOS ONE.2021; 16(4): e0250035. CrossRef
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 149. CrossRef

Infection
Sepsis in Patients Receiving Immunosuppressive Drugs in Korea: Analysis of the National Insurance Database from 2009 to 2013: Seung-Young Oh, Songhee Cho, Hannah Lee, Eun Jin Chang, Se Hee Min, Ho Geol Ryu; Korean J Crit Care Med. 2015;30(4):249-257. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.249

11,347 View
203 Download
6 Crossref

Abstract PDF

Background
The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis.
Methods
Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed.
Results
Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality.
Conclusions
Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.

Citations

Citations to this article as recorded by

Predictive performance of NEWS and qSOFA in immunocompromised sepsis patients at the emergency department
Lisanne Boekhoud, Helena M. E. A. Schaap, Rick L. Huizinga, Tycho J. Olgers, Jan C. ter Maaten, Douwe F. Postma, Hjalmar R. Bouma
Infection.2024; 52(5): 1863. CrossRef
Effects of Early Initiation of High-Dose Dexamethasone Therapy on Pro-Inflammatory Cytokines and Mortality in LPS-Challenged Mice
Ji-young Son, Won Gun Kwack, Eun Kyoung Chung, Sooyoung Shin, Yeo Jin Choi
Healthcare.2022; 10(7): 1247. CrossRef
Alleviation of LPS-Induced Inflammation and Septic Shock by Lactiplantibacillus plantarum K8 Lysates
Gayoung Kim, Kyeong-Hun Choi, Hangeun Kim, Dae-Kyun Chung
International Journal of Molecular Sciences.2021; 22(11): 5921. CrossRef
Critical Care Research Using “Big Data”: A Reality in the Near Future
Kwangha Lee
Acute and Critical Care.2018; 33(4): 269. CrossRef
Should Very Old Patients Be Admitted to the Intensive Care Units?
Jun Kwon Cha, In-Ae Song
The Korean Journal of Critical Care Medicine.2017; 32(4): 376. CrossRef
Sepsis in Immunocompromised Patients: Current Status in Korea
Kwangha Lee
The Korean Journal of Critical Care Medicine.2015; 30(4): 239. CrossRef

Case Report

A Case of Peripheral T Cell Lymphoma Presenting as Severe Hypoxic Respiratory Failure: A Case Report: Joon Seok Choi, Hong Joon Shin, Eun Young Kim, In Jae Oh, Kyu Sik Kim, Yu Il Kim, Sung Chul Lim, Young Chul Kim, Yoo Duk Choi, Hyun Ju Seon, Yong Soo Kwon; Korean J Crit Care Med. 2010;25(1):43-47.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.43

3,518 View
35 Download

Abstract PDF: We describe here the first known case in Korea of pulmonary involvement with peripheral T cell lymphoma and the patient presented with severe hypoxic respiratory failure. A 57-yr-old man was admitted to our hospital with rapid progression of dyspnea and bilateral diffuse infiltration on a chest radiograph. He received mechanical ventilation and low dose corticosteroid treatment under the suspicion of critical illness-related corticosteroid insufficiency. Transbronchial lung biopsy revealed large atypical lymphoid cells with positivity for CD3+. We diagnosed this patient as having a peripheral T cell lymphoma and we treated him with high dose corticosteroid. His clinical and radiologic findings rapidly improved and then he received a full dose of chemotherapy for the peripheral T cell lymphoma.

First
Prev
Page of 1
Next
Last

Search