rss
BMJ Case Reports 2017; doi:10.1136/bcr-2017-220328
  • Unexpected outcome (positive or negative) including adverse drug reactions
  • CASE REPORT

Ominous triad triggered by high-dose glucocorticosteroid therapy

  1. Thomas Zueger1
  1. 1Division of Internal Medicine, Hospital Tiefenau, Inselgruppe AG, University of Bern, Bern, Switzerland
  2. 2Division of Intensive Care, Hospital Tiefenau, Inselgruppe AG, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Thomas Zueger, thomas.zueger{at}spitaltiefenau.ch
  • Accepted 26 April 2017
  • Published 18 June 2017

Summary

Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis—a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy. Our patient’s condition was further aggravated by a circulatory shock, haemodynamic relevant bleeding from a duodenal ulcer and psychotic symptoms. In the intensive care unit, intravenous insulin infusion, fluid resuscitation, catecholamine support, electrolyte supplementation, endoscopic haemoclipping and antibiotic and antipsychotic treatment were administered, leading to a continuous improvement of the patient’s health state.

Footnotes

  • Contributors SB, FD and TZ were all involved in the treatment of the patient. SB and TZ drafted the manuscript and FD thoroughly revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article