Zusammenfassung
Glukokortikoide sind wirksame Medikamente zur Behandlung der Colitis ulcerosa. Das Auftreten von Nebenwirkungen ist von der Dosis und Dauer der Behandlung abhängig und kann bei langjähriger Einnahme bis zu 80% betragen. Eine seltene unerwünschte Wirkung der Glukokortikoidtherapie ist die steroidinduzierte Myopathie. Es existiert eine akute und eine chronische Form. Die chronische Steroidmyopathie betrifft vornehmlich die Muskulatur des Schulter- und Beckengürtels und äußert sich in einer proximalen Muskelschwäche. Histologisch findet sich eine Atrophie der Typ-IIb-Muskelfasern. Die chronische Steroidmyopathie entsteht nach längerer Einnahme einer mittleren bis höheren Dosis von Glukokortikoiden. Eigener Fall: In der vorgestellten Kasuistik, entwickelte ein 25jähriger Patient mit linksseitiger Colitis ulcerosa nach monatelanger Glukokortikoidbehandlung eine chronische Steroidmyopathie. Nach Umstellung von der oralen systemischen Steroidbehandlung auf Budesonid besserte sich die Myopathie. Die linksseitige Colitis ulcerosa blieb in Remission. Schlußfolgerung: Der Fall dokumentiert das Verschwinden einer bedeutsamen Steroidnebenwirkung nach Umstellung von einer systemischen Steroidtherapie auf Budesonid.
Summary
Glucocorticoids are an effective treatment of ulcerative colitis. The occurrence of steroid side effects depends on dosage and duration of steroid treatment. It may be as high as 80%. A rare side effect of glucocorticoid therapy is steroid induced myopathia. There exists an acute and a chronic from of steroid induced myopathia. Chronic steroid myopathia affects mainly the proximal musculature of the lower and upper extremities and leads to proximal muscle weakness. Histologically, an atrophy of type IIb-muscle fibers can be found. Chronic steroid myopathia occurs after prolonged treatment with higher doses of glucocorticoids. The case report describes a 25-year-old male patient with left-sided ulcerative colitis who developed chronic steroid myopathia after several months of glucocorticoid treatment. After switching from systemic steroids to budesonide the symptoms of myopathia disappeared. Left-sided ulcerative colitis remained in remission. Conclusion: The case documents the disappearance of a severe steroid side effect after switching from a systemic steroid to budesonide.
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Caesar, I., Gross, V., Roth, M. et al. Steroidinduzierte Myopathie bei linksseitiger Colitis ulcerosa. Coloproctol 20, 18–23 (1998). https://doi.org/10.1007/BF03043678
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DOI: https://doi.org/10.1007/BF03043678