Advertisement

Rheumatology International

, Volume 38, Issue 12, pp 2337–2343 | Cite as

Dose-dependent bradycardia as a rare side effect of corticosteroids: a case report and review of the literature

  • Döndü Üsküdar CansuEmail author
  • Erdal Bodakçi
  • Cengiz Korkmaz
Cases with a Message
  • 145 Downloads

Abstract

Corticosteroids rank at the first place among the most commonly used immunosuppressive agents in the rheumatology practice. Although their conventional adverse effects including hyperglycemia, hypertension, hyperlipidemia, and osteoporosis are well-recognized and managed, steroid-induced cardiac arrhythmias are known to a lesser extent. In this regard, steroid-associated bradycardia is rarely expected and not very well known. Reported cases of steroid-associated bradycardias in the literature predominantly have emerged during the course of intravenous high-dose (pulse) methylprednisolone (MP) administrations. In this paper, we report a patient who developed sinus bradycardia following 52 mg of oral MP administration, improved once the drug was discontinued but repeated with the re-administration. Hence, the patient was shifted to prednisolone (PRED), and again suffered bradycardia which recovered upon dose reduction. Presenting this case along with other similar rare cases in the literature, our aim is to draw attention of fellow rheumatologists, who widely use steroids, to bradycardia—a rare and dose-dependent side effect of steroids.

Keywords

Corticosteroids Arrhythmias Rheumatology Bradycardia 

Notes

Author contributions

Study concept and design: DUC, EB, and CK; analysis and interpretation of data: DUC, EB, and CK; drafting of the manuscript: DUC; critical revision of the manuscript for important intellectual content: DUC, EB, and CK; study supervision: DUC, EB, and CK.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from our patient.

References

  1. 1.
    Vasheghani-Farahani A, Sahraian MA, Darabi L, Aghsaie A, Minagar A (2011) Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multiple sclerosis. J Neurol Sci 309:75–78PubMedCrossRefGoogle Scholar
  2. 2.
    Barnes BJ, Hollands JM (2010) Drug-induced arrhythmias. Crit Care Med 38:S188–S197PubMedCrossRefGoogle Scholar
  3. 3.
    Osuagwu F, Jahnke B (2016) Intravenous methylprednisolone-induced nocturnal sinus bradycardia in a multiple sclerosis patient. Prim Care Companion CNS Disord 18:2Google Scholar
  4. 4.
    Nagakura A, Morikawa Y, Sakakibara H, Miura M (2017) Bradycardia associated with prednisolone in children with severe Kawasaki disease. J Pediatr 185:106–111PubMedCrossRefGoogle Scholar
  5. 5.
    Tvede N, Nielsen LP, Andersen V (1986) Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol 15:302–304PubMedCrossRefGoogle Scholar
  6. 6.
    Guillén EL, Ruíz AM, Bugallo JB (1998) Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient. Am J Kidney Dis 32:E4PubMedCrossRefGoogle Scholar
  7. 7.
    Pudil R, Hrncir Z (2001) Severe bradycardia after a methylprednisolone “minipulse” treatment. Arch Intern Med 161:1778–1779PubMedCrossRefGoogle Scholar
  8. 8.
    Darling HS, Marwah V, Rajput AK, Varma PP, Singh KK (2013) Low dose methylprednisolone induced bradycardia. J Assoc Physicians India 61:920–922PubMedGoogle Scholar
  9. 9.
    Beyan E, Urün Y, Uzuner A (2004) Bradycardia due to methylprednisolone therapy. J Clin Rheumatol 10:230PubMedCrossRefGoogle Scholar
  10. 10.
    Ohshima M, Kawahata K, Kanda H, Yamamoto K (2017) Sinus bradycardia after intravenous pulse methylprednisolone therapy in patients with systemic lupus erythematosus. Mod Rheumatol 1:1–4 (Epub ahead of print) CrossRefGoogle Scholar
  11. 11.
    Stroeder J, Evans C, Mansell H (2015) Corticosteroid-induced bradycardia: case report and review of the literature. Can Pharm J (Ott) 148:235–240CrossRefGoogle Scholar
  12. 12.
    Kundu A, Fitzgibbons TP (2015) Acute symptomatic sinus bradycardia in a woman treated with pulse dose steroids for multiple sclerosis: a case report. J Med Case Rep 24;9:216PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Taylor MR, Gaco D (2013) Symptomatic sinus bradycardia after a treatment course of high-dose oral prednisone. J Emerg Med 45:e55–e58PubMedCrossRefGoogle Scholar
  14. 14.
    Marinov M, Fuessel MU, Unterrainer AF (2013) Bradycardia after dexamethasone for postoperative nausea and vomiting prophylaxis during induction of anaesthesia. Br J Anaesth 111:1025–1026PubMedCrossRefGoogle Scholar
  15. 15.
    John PR, Khaladj-Ghom A, Still KL (2016) Bradycardia associated with steroid use for laryngeal edema in an adult: a case report and literature review. Case Rep Cardiol 2016:9785467PubMedPubMedCentralGoogle Scholar
  16. 16.
    Hasan AQ, Al-Khazraji A (2016) Corticosteroids-induced bradycardia: a case report and literature review. J Med Sci Clin Res 4:1566–11569Google Scholar
  17. 17.
    Soni R, Kumar R, Debnath J (2017) Hydrocortisone induce bradyarrhythmias: a case report. Int J Sci Rep 3:13–14CrossRefGoogle Scholar
  18. 18.
    Li J, Azaad MA, Li Y, Zhang Q (2017) Sinus bradycardia rare but expected complications of chemo regimen involving dexamethasone: case report. Open J Blood Dis 7:47–50CrossRefGoogle Scholar
  19. 19.
    Jain R, Bali H, Sharma VK, Kumar B (2005) Cardiovascular effects of corticosteroid pulse therapy: a prospective controlled study on pemphigus patients. Int J Dermatol 44:285–288PubMedCrossRefGoogle Scholar
  20. 20.
    Al Shibli A, Al Attrach I, Hamdan MA (2012) Bradycardia following oral corticosteroid use: case report and literature review. Arab J Nephrol Transplant 5:47–49PubMedGoogle Scholar
  21. 21.
    Orgun A, Gursu HA, Cetin II (2018) Wolff–Parkinson–White syndrome presenting with steroid-induced bradycardia in a patient with acute rheumatic fever. Cardiol Young 2:1–3Google Scholar
  22. 22.
    Domínguez-Pinilla N, Del Fresno-Valencia MR, de Inocencio Arocena J, Enríquez Merayo E (2014) Sinus bradycardia secondary to the use of pulse corticosteroids [article in Spanish]. An Pediatr (Barc) 80:331–332CrossRefGoogle Scholar
  23. 23.
    van der Gugten A, Bierings M, Frenkel J (2008) Glucocorticoid-associated Bradycardia. J Pediatr Hematol Oncol 30:172–175PubMedCrossRefGoogle Scholar
  24. 24.
    Hsu DT (2008) Steroids and bradycardia: how slow can you go? J Pediatr Hematol Oncol 30:119–120PubMedCrossRefGoogle Scholar
  25. 25.
    Akikusa JD, Feldman BM, Gross GJ, Silverman ED, Schneider R (2007) Sinus bradycardia after intravenous pulse methylprednisolone. Pediatrics 119:e778–e782PubMedCrossRefGoogle Scholar
  26. 26.
    Küçükosmanoğlu O, Karabay A, Ozbarlas N, Noyan A, Anarat A (1998) Marked bradycardia due to pulsed and oral methylprednisolone therapy in a patient with rapidly progressive glomerulonephritis. Nephron 80:484PubMedCrossRefGoogle Scholar
  27. 27.
    Puntis JW, Morgan ME, Durbin GM (1988) Dexamethasone-induced bradycardia. Lancet 2:1372PubMedCrossRefGoogle Scholar
  28. 28.
    Ohlsson A, Heyman E (1988) Dexamethasone-induced bradycardia. Lancet 2:1074PubMedCrossRefGoogle Scholar
  29. 29.
    Berkenbosch JW, Tobias JD (2003) Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med 4:203–205PubMedCrossRefGoogle Scholar
  30. 30.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineEskişehir Osmangazi UniversityEskisehirTurkey

Personalised recommendations