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Bradycardia after pulse methylprednisolone therapy in a child-Uncommon side effect of a frequently used drug: A case report
Journal article   Open access   Peer reviewed

Bradycardia after pulse methylprednisolone therapy in a child-Uncommon side effect of a frequently used drug: A case report

Saroj Tripathy, Sarthak Das and Archana Malik
Journal of family medicine and primary care, v 12(5), pp 1006-1008
01 May 2023
DOI: https://doi.org/10.4103/jfmpc.jfmpc_2167_22
PMID: 37448929
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.4103/jfmpc.jfmpc_2167_22View
Published, Version of Record (VoR) Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Primary Health Care Science & Technology
Corticosteroids are potent anti-inflammatory agents used as a mainstay of therapy in most of the rheumatologic disorders. Common side effects of pulse steroid therapy include hypertension, hyperglycemia, seizure, hypokalemia, and infection. We report a case of an 11-year-old girl with polyarticular Juvenile idiopathic arthritis who developed bradycardia following pulse methylprednisolone therapy. On day 2 of methylprednisolone infusion, she developed bradycardia with a heart rate between 50 and 60/min. ECG was suggestive of sinus bradycardia. There was no evidence of dyselectrolytemia (Na-141 mmol/l, K-3.54 mmol/l, Ca-8.72 mg/l) or sepsis. The patient did not receive methylprednisolone on day 3 and vitals continued to be monitored. Her heart rate improved after 12 hours. In the mid of infusion on day 4, again the patient had bradycardia with a heart rate of 50-60/minute. Since she was hemodynamically stable, we continued the infusion, and bradycardia resolved in the next 8 hours. On follow-up after 2 weeks, she had some improvement in joint symptoms and normal heart rate. As per Naranjo adverse drug reaction probability scale, the adverse reaction in our case was probable with a score of 8. Although bradycardia associated with pulse steroid therapy is benign and is usually reversible following cessation of therapy, a baseline heart rate, ECG, and electrolyte level are suggested before infusion as a cautionary measure to minimize serious adverse events.

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