Methylprednisolone sodium succinate
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Allergy: case report A 63-year-old man experienced allergy during treatment with methylprednisolone sodium succinate. The man, who had a history of asthma, was hospitalised with tense blisters on his feet, fever and lower limb oedema and pain. Rickettsia infection was suspected; however, his fever did not abate with minocycline, and he developed asthma attacks. A dexamethasone drip was started for his asthma; his fever, coughing, dyspnoea and lower limb-pain improved. Investigations were suggestive of Churg-Strauss syndrome. As Churg-Strauss syndrome was suspected and as he had an increased eosinophil count and inflammatory response, a methylprednisolone sodium succinate drip was started from 1 September [dosage not stated]. On September 6, he developed pyrexia; additionally, eosinophil proliferation continued and his lower limb pain worsened. Resistance to corticosteroid treatment was suspected, and he was transferred to another hospital on 13 September. On transfer, he had a temperature of 38.4°C and a BP of 108/60mm Hg. Following investigation, a diagnosis of Churg-Strauss syndrome was confirmed. Because of his response at the previous hospital, it was thought there was resistance to corticosteroid treatment; however, after being transferred he had started oral prednisolone, and his symptoms had improved. Subsequently, an allergy to methylprednisolone sodium succinate was suspected. A methylprednisolone sodium succinate drip (62.5 mg/day; total: 5 days) was started as a challenge test. His leg pain subsequently worsened, his eosinophil count increased and his CRP and other inflammatory reactions were aggravated. The challenge was judged positive, and he once again received oral prednisolone. His fever abated, his eosinophil count decreased and his inflammation and lower leg pain improved. At last follow-up, he was undergoing outpatient treatment without recurrence. Author comment: We experienced a case in which a drug allergy occurred from methylprednisolone sodium succinate used to treat Churg-Strauss syndrome. Since the drug allergy symptoms were the same as the symptoms of Churg-Strauss syndrome, the case was initially judged to be steroid resistant. Yoneda T, et al. [A case of Churg-Strauss syndrome with methylprednisolone sodium succinate allergy]. [Japanese]. Nihon Kokyuki Gakkai Zasshi 47: 1147-50, 803010609 No. 12, Dec 2009 [Japanese; summarised from a translation] - Japan
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Reactions 17 Apr 2010 No. 1297
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