Muscle weakness is now recognized as an uncommon though serious complication of steroid therapy, with most of the synthetic adrenal corticosteroids in clinical use. Although biopsies have shown structural changes in some of the reported cases of steroid induced weakness, this case provides the only example known to us in which necropsy afforded the opportunity for extensive study of multiple muscle groups. The case described in this paper is that of an older man who developed disabling muscular weakness while receiving a variety of steroids for a refractory anemia.

This patient was a 65 -- year old white male accountant who entered the New York Hospital for his fourth and terminal admission on June 26, 1959, because of disabling weakness and general debility.

In 1953 the patient developed an unexplained anemia for which 15 blood transfusions were given over a period of 4 years. Splenomegaly was first noted in 1956, and a sternal marrow biopsy at that time showed ``scattered foci of fibrosis'' suggestive of myelofibrosis. No additional transfusions were necessary after the institution of prednisone in July, 1957, in an initial dose of 40 mg. daily with gradual tapering to 10 mg. daily. This medication was continued until February, 1958.

In February, 1958, the patient suffered a myocardial infarction complicated by pulmonary edema. Additional findings at this time included cardiomegaly, peripheral arteriosclerosis obliterans, and cholelithiasis. The hemoglobin was 11.6 gm.. Therapy included digitalization and anticoagulation. Later, chlorothiazide and salt restriction became necessary to control the edema of chronic congestive failure.