title: Can "steroid switching" improve steroid-induced musical hallucinations in a patient with terminal cancer?
abstract: The patient was a 57-year-old woman with malignant pleural mesothelioma. She had a past history of anxiety neurosis but not had any history of otological diseases. On admission to our hospice (day 1), she complained of dyspnea and wheezing associated with the progression of her underlying disease. After we started oral betamethasone (2 mg/d), dyspnea was alleviated and the frequency of wheezing was reduced. On day 3, she began to experience musical hallucinations that were manifested in opera/piano concert music and a child's voice. The episodes of musical hallucinations occurred approximately 10 times a day and disappeared spontaneously within several minutes. She had not experienced these symptoms before. We reduced the dose of betamethasone to 1 mg/d, but the musical hallucinations continued. Then on day 11, we switched betamethasone (1 mg/d) to prednisolone (10 mg/d) and we then gradually tapered off prednisolone. The frequency of musical hallucinations decreased and she ceased to experience musical hallucinations on day 29. However, on day 40, her dyspnea was aggravated again, so we started treatment with prednisolone (5 mg/d). Dyspnea was alleviated and no musical hallucinations occurred. On Day 51, dyspnea was worsened and we switched prednisolone to betamethasone (4 mg/d), which she hoped to use. The betamethasone alleviated the dyspnea but she developed musical hallucinations that were similar to the previous episodes. The musical hallucinations disappeared spontaneously 4-5 days later without changing the betamethasone. Musical hallucinations never occurred thereafter. She later died due to the exacerbation of disease.
authors.affiliation: Hospice, Gratia Hospital, Mino, Osaka 562-8567, Japan. k.seitetsu@gmail.com
authors.forename: Seitetsu
authors.initials: S
authors.lastname: Kanemura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanimukai
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
mesh_terms: D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006212:Hallucinations / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008654:Mesothelioma; D008875:Middle Aged; D010997:Pleural Neoplasms; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011605:Psychoses, Substance-Induced / Q000209:etiology / Q000517:prevention & control*; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use*; D013727:Terminal Care
chemical_list: D005938:Glucocorticoids; D013256:Steroids; D001623:Betamethasone; D011239:Prednisolone