A case of suspected steroid withdrawal syndrome from discontinuation of topical steroid medication

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  • TAGA Sho
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center
  • HATAKEYAMA Junji
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University
  • YAMAMOTO Taihei
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center Intensive Care Unit, Kameda Medical Center
  • MUROYA Naoki
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center Department of Orthopaedic Surgery, Keio University Hospital
  • OBIKAWA Fumio
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center
  • AICHI Shogo
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center
  • OMOTO Kenichiro
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center Department of Emergency Medicine, Nippon Medical School Tamanagayama Hospital
  • KURIHARA Tomohiro
    Department of Emergency and Critical Care Medicine,  National Organization Tokyo Medical Center

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Other Title
  • ステロイド外用薬の中止からステロイド離脱症候群が疑われた1例
  • ステロイド ガイヨウヤク ノ チュウシ カラ ステロイド リダツ ショウコウグン ガ ウタガワレタ 1レイ

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<p>A 47-year-old man with a history of mycosis fungoides was transported to our hospital in a state of shock, indicated by evaluation of his vital signs on admission. We suspected tumor collapse syndrome and septic shock and administered steroids for management of septic shock-induced relative adrenal insufficiency. The patient’s circulatory status rapidly improved; however, he subsequently developed two episodes of circulatory failure following steroid discontinuation. Detailed medical history obtained from the family revealed long-term topical steroid use. We suspected steroid withdrawal syndrome and re-initiated steroid therapy. The patient’s general condition improved, although he developed progressive pneumonia and septic shock and multiorgan failure during the course of treatment and died of these complications. Autopsy revealed significant thinning of the adrenal glands. Interpretation of the results of random serum cortisol levels may be inaccurate in emergency and intensive care settings. Clinicians should include steroid withdrawal syndrome secondary to discontinuation of topical steroids as well as oral medications in the differential diagnosis of shock. </p>

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