Hydrocortisone/prednisone/unspecified corticosteroids
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Various toxicities: case report A 60-year-old woman developed diabetes, weight gain with cushingoid appearance, polymyalgia, hyperosmolar syndrome and increased intraocular pressure following treatment with prednisone, hydrocortisone and unspecified corticosteroids for hypocomplementemic urticarial vasculitis syndrome (HUVS) [not all routes, dosages and outcomes stated; durations of treatments to reactions onsets not stated]. The woman, who had recurrent urticarial lesions, was diagnosed with HUVS. She started receiving prednisone 60 mg/day. However, she started experiencing new flares of erythematousedematous lesions when the prednisone dose was reduced to below 10 mg/day. Therefore, she started receiving additional therapy with levocetirizine (antihistamine). She had elevated intraocular pressure. She continued receiving prednisone at a dose of 10–15 mg/day. She also received additional therapy with azathioprine and dapsone. However, her pruritic maculopapular lesions persisted. She was treated with unspecified IM corticosteroids. She started experiencing corticosteroid-induced adverse effects consisting of diabetes, secondary hyperosmolar syndrome, polymyalgia, weight gain of 20kg with cushingoid appearance and increased intraocular pressure. She required hospital emergency care for hyperosmolar syndrome. Thereafter, the woman started receiving off-label treatment with omalizumab 300mg every 4 weeks in 2015. Her treatment with azathioprine and prednisone 10–15 mg/day was maintained till improvement in skin lesions. After seven months, both azathioprine and prednisone were discontinued. Five months later, she developed severe flare of her HUVS lesions. Therefore, she was treated with prednisone 80 mg/day. Omalizumab dose was also increased 450mg every 4 weeks. Thereafter, the skin lesions resolved. Thereafter, prednisone dose was decreased over 2–3 months. Subsequently, prednisone was switched to hydrocortisone until recovery of hypothalamic-pituitary-adrenal axis function. Later, all corticosteroids were discontinued. Thereafter, corticosteroidinduced diabetes and cushingoid appearance resolved. She lost 18Kg of weight. One year later, the woman developed several episodes of facial angioedema and tongue swelling due to underlying HUVS, which was treated with prednisone 80 mg/day. Thereafter, omalizumab dose frequency was increased to 450mg to every 2 weeks, leading to complete remission of the skin lesions and angioedema. Upon follow-up, she was noted to be asymptomatic with omalizumab alone since 2017. Perez Codesido S, et al. Successful treatment of hypocomplementemic urticarial vasculitis with omalizumab: A case report. Journal of Investigational Allergology and Clinical 803499901 Immunology 30: 211-212, No. 3, 2020. Available from: URL: http://doi.org/10.18176/jiaci.0486
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Reactions 5 Sep 2020 No. 1820
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