Steroid-induced myopathy in the ICU.
OBJECTIVE
To report a case of steroid-induced myopathy resulting from prolonged administration of corticosteroids in an asthmatic patient in a medical intensive care unit.


METHODS
A 30-year-old white man presented with status asthmaticus requiring intubation for respiratory failure. His hospital course was complicated by the need for reintubation and the development of "quadriplegia." Electromyography does not identify neuropathy. After rapid tapering of systemic steroids, the patient quickly regained muscle strength, was extubated, and was transferred to a rehabilitation facility for prolonged physical therapy.


CONCLUSIONS
Steroid-induced myopathy is a rare occurrence in the intensive care setting. Cases of myopathy that have been reported have been associated with prolonged and combined use of corticosteroids with neuromuscular blocking agents or aminoglycosides. Corticosteroids are thought to produce deleterious effects through 1 or all of 3 main pathways: altered electrical excitability of muscle fibers, loss of thick filaments, and/or inhibition of protein synthesis. All of these pathways are believed to increase the rate of muscle catabolism and result in loss of muscle movement.


CONCLUSIONS
Steroid-induced myopathy is a complication of high-dose steroid use. Unfortunately, in this patient, initial treatment of status asthmaticus required intravenous steroids in high doses to adequately treat the presenting illness. Clinicians should be aware of neuromuscular findings and act aggressively to appropriately eliminate systemic steroids from the treatment regimen.
Polsonetti
Bryan W
BW
Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT 06510, USA. Polsonb2@ynhh.org
Joy
Saju D
SD
Laos
Luis F
LF
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000534:rehabilitation; D013224:Status Asthmaticus / Q000188:drug therapy
D000305:Adrenal Cortex Hormones