A case of suspected steroid withdrawal syndrome from discontinuation of topical steroid medication

Abstract

A 47-year-old man with a history of mycosis fungoides was transported to our hospital in a state of shock, indicated by evaluation of his vital signs on admission. We suspected tumor collapse syndrome and septic shock and administered steroids for management of septic shock-induced relative adrenal insufficiency. The patient’s circulatory status rapidly improved; however, he subsequently developed two episodes of circulatory failure following steroid discontinuation. Detailed medical history obtained from the family revealed long-term topical steroid use. We suspected steroid withdrawal syndrome and re-initiated steroid therapy. The patient’s general condition improved, although he developed progressive pneumonia and septic shock and multiorgan failure during the course of treatment and died of these complications. Autopsy revealed significant thinning of the adrenal glands. Interpretation of the results of random serum cortisol levels may be inaccurate in emergency and intensive care settings. Clinicians should include steroid withdrawal syndrome secondary to discontinuation of topical steroids as well as oral medications in the differential diagnosis of shock.