All issues > Volume 53(3); 2010

Case Report

Korean J Pediatr. 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 SY Kim¹, Jae Min JM Lee¹, Yong Hoom YH Park¹

¹Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea

Correspondence Yong Hoom YH Park ,Email: yhpark@ynu.ac.kr

Received: September 15, 2009; Revised: October 19, 2009   Accepted: December 10, 2009.

Abstract

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.

Keywords :Nephrotic syndrome, Toxic epidermal necrolysis, Steroid-induced psychosis