Prednisone

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case series of 6 patients, a 63-year-old woman (case 3) was described, who developed posterior vitreous detachment (PVD) of the left eye secondary to an increased intraocular pressure during treatment with prednisone for post-viral vestibular neuritis.

The woman, who had a history of aplastic anaemia, mitral valve prolapse with regurgitation, celiac disease and motion sickness, presented with a runny nose and shortness of breath with activity. She did not have fever, chills, cough, wheezing or chest pain. Given the past history of aplastic anaemia, she took over-the-counter iron pills for shortness of breath with no improvement. The symptoms developed in March 2020 when there were no reported COVID-19 cases. Due to lack of improvement despite a few days of symptomatic management, the PCR on nasal swab for the SARS-CoV-2 test was performed in an ambulatory setting. She tested positive for COVID-19 and was home quarantined. About four weeks after the initial episode, she developed twitching of her left eye and left cheek, non-bloody diarrhoea, generalised weakness, palpitations, sleep disturbances, decreased appetite, skin rash, anosmia and dysgeusia. The twitching was involuntary, initially involving the left eye which then progressed to the left side of the face. There were no evidence of pain, loss of sensation or numbness. There were 8 to 10 painful, red skin lesions around 3mm in size over perioral area. She was clinically diagnosed with herpes labialis. She received conservative management with ample hydration, unspecified antipyretics, over-the-counter aspirin, multivitamin and calcium supplements. She showed some clinical improvement over a 4-week period. She tested negative for COVID-19 on the 58 ^th day. A week post being tested negative for COVID-19, she suddenly developed chills and vomiting. She woke up in the middle of the night with dizziness, a sense of the room spinning and an unsteady gait. She did not have tinnitus or hearing loss. She immediately sought medical attention and the physical examination showed a strong nystagmus to the right. She was confirmed to have vertigo and was diagnosed with post-viral vestibular neuritis. She was treated initially with meclizine, unspecified antiemetics and Cawthorne vestibular rehabilitation exercises. Due to lack of symptomatic improvement she was subsequently given prednisone 60mg [route not stated] with a gradual taper over the next 10 days. On the 10 ^th day of prednisone, she noticed a sudden onset of flashes and floaters in the left eye. A slit-lamp examination diagnosed PVD of the left eye. The PVD was attributed to an increase in intraocular pressure with the use of prednisone.

Consequently, prednisone was stopped. There was a slight improvement in her vision post cessation of prednisone.