Ominous triad triggered by high-dose glucocorticosteroid therapy

Area of Science:

• Endocrinology
• Neurology
• Gastroenterology

Background:

• Glucocorticosteroids (CS) are vital in treating various diseases but carry risks of adverse effects.
• Multiple sclerosis relapse management often involves high-dose CS therapy.

Observation:

• A 51-year-old woman received high-dose CS for multiple sclerosis relapse.
• Within 5 days, she developed diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis.
• Her condition worsened with circulatory shock, duodenal ulcer bleeding, and psychosis.

Findings:

• This presentation represents the first reported instance of this triad as a complication of CS therapy.
• The patient required intensive care, including insulin infusion, fluid resuscitation, and hemodynamic support.
• Endoscopic interventions and supportive treatments were crucial for stabilization.

Implications:

• This case underscores the critical need for vigilant monitoring of patients on high-dose CS.
• Early recognition and management of this rare triad are essential for patient survival.
• Further research may elucidate the precise mechanisms linking CS to this severe adverse event.