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Steroid-induced acute psychosis in a child with asthma: report of one case

K M Lee1, Y Z Lin, F Y Huang

  • 1Department of Pediatrics, Taipei Municipal Chung Hsiao Hospital, Tung The Road, Nang Kung, Taipei 11502, Taiwan.

Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi
|July 4, 2001
PubMed

Insights

A severe asthma attack in a child led to a psychotic reaction, likely caused by high-dose steroid treatment. Reducing the steroid dosage resolved the symptoms, suggesting a link between corticosteroids and pediatric psychosis.

Area of Science:

  • Pediatric Pulmonology
  • Pediatric Psychiatry
  • Clinical Pharmacology

Background:

  • Severe asthma exacerbations in children require aggressive treatment.
  • Corticosteroids and aminophylline are common therapies for severe asthma.
  • Psychiatric side effects of medications can complicate pediatric care.

Observation:

  • A 5-year-old girl experienced a severe asthmatic attack and received intravenous methylprednisolone, aminophylline, and nebulized terbutaline.
  • On day 3, she developed acute psychosis with visual hallucinations, delusions, panic, and myoclonus, despite a therapeutic theophylline level.
  • Symptoms resolved rapidly after reducing methylprednisolone dosage and switching to inhaled procaterol.

Findings:

  • The patient exhibited acute psychotic symptoms during high-dose intravenous methylprednisolone therapy for asthma.
  • The theophylline level was within the therapeutic range, ruling out aminophylline toxicity as the cause.
  • Psychotic symptoms resolved promptly upon reduction of methylprednisolone and transition to inhaled corticosteroids.

Implications:

  • High-dose corticosteroids may induce transient psychotic reactions in children with severe asthma.
  • Careful monitoring for psychiatric side effects is crucial during intensive asthma treatment.
  • This case highlights the potential neurotoxicity of corticosteroids in pediatric patients and the importance of dose adjustment.

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