Steroid myopathy in a child with diffuse alveolar hemorrhage: a case report

Steroid myopathy (SM) is a side effect of glucocorticoid administration. Previous reports of SM after glucocorticoid therapy for respiratory diseases have focused on asthma and chronic obstructive pulmonary disease in adults or adolescents. To our knowledge, there have been no reports of SM after treatment with glucocorticoid for diffuse alveolar hemorrhage (DAH) in preschoolers. We present a 4-year-old girl with DAH requiring the treatment with methylprednisolone, who was transferred to the pediatric intensive care unit (PICU) due to respiratory failure caused by severe pneumonia requiring mechanical ventilation. When transferred to respiratory department, the strength of the limbs of the patient decreased, and her lower limbs were paralyzed. We performed relevant examination to rule out juvenile dermatomyositis and other diseases such as deep venous thrombosis of lower limbs, Guillain-Barre syndrome that may cause the decline of muscle strength. SM was considered based on the clinical characteristics and risk factors of the child, so glucocorticoid treatment was tapered following the treatment regimen for DAH and SM. The muscle strength of the child completely recovered, which further confirmed our diagnosis of SM. In pediatrics, SM should also be a concern when patients with respiratory disease experience decreased muscle strength following glucocorticoid therapy.