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A case of steroid-induced psychosis in a child having nephrotic syndrome with toxic epidermal necrolysis

Korean Journal of Pediatrics 2010;53(3):437-441.
Published online March 15, 2010.
A case of steroid-induced psychosis in a child having nephrotic syndrome with toxic epidermal necrolysis
Sae Yoon Kim, Jae Min Lee, Yong Hoom Park
Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
신증후군 환아에서 발생한 독성표피괴사용해 치료를 위해 사용된 고용량 스테로이드로 인한 정신질환 1례
김세윤, 이재민, 박용훈
영남대학교 의과대학 소아과학교실
Yong Hoom Park, Email: yhpark@ynu.ac.kr
Received: 15 September 2009   • Revised: 19 October 2009   • Accepted: 10 December 2009
Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare, life-threatening mucocutaneous diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.
Key Words: Nephrotic syndrome, Toxic epidermal necrolysis, Steroid-induced psychosis

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