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Glucocorticoid-Induced Myopathy in a Patient with Systemic Lupus Erythematosus
(SLE): A Case Report and Review of the Literature
#MMPMID29525810
Silver EM
; Ochoa W
Am J Case Rep
2018[Mar]; 19
(?): 277-283
PMID29525810
show ga
BACKGROUND Chronic intake of high-dose corticosteroids is associated with
multiple adverse clinical effects, including hypertension, insulin resistance,
impaired wound healing, immunosuppression, myopathy, and osteoporosis. In cases
of autoimmune disease, use of steroid-sparing treatment modalities is preferred
over chronic steroid therapy to limit these side effects. Glucocorticoid-induced
myopathy is a less common side effect of chronic steroid use in patients treated
with <10 mg/day of prednisone. However, doses exceeding 40-60 mg/day can induce
clinically significant myopathy and weakness. CASE REPORT A 35-year-old woman
with a past medical history of hypothyroidism, systemic lupus erythematosus
(SLE), and end-stage renal disease secondary to lupus nephritis, on hemodialysis,
presented to the local emergency department with progressive bilateral proximal
lower extremity weakness. Three months before admission, when her insurance
company prematurely discontinued her monthly cyclophosphamide injections, at
which time, she was treated with prednisone 60 mg daily. Two months before
hospital admission, she reported increasing fatigue, weight gain, difficulty in
standing from a seated position and climbing stairs. CONCLUSIONS Elucidating the
etiology of progressive neuromotor deficit in immunosuppressed patients can be
difficult. The management of SLE and other autoimmune diseases with chronic
high-dose steroids is associated with recognized side effects. Differentiating
natural disease progression from iatrogenic etiologies is important in this
subset of patients, particularly to reduce prolonged clinical management and
hospital admissions.
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