Hydrocortisone/prednisolone

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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

A 62-year-old man developed weight gain, blood sugar level fluctuations and SARS-CoV-2 infection during treatment with prednisolone, and further worsening of SARS-CoV-2 infection during treatment with prednisolone and hydrocortisone for autoimmune periaortitis [not all routes, dosages and outcomes stated; durations of treatments to reactions onsets not stated].

The man, who had periaortitis, contracted SARS-CoV-2 infection while receiving high-dose prednisolone 35 mg/day. Owing to the symptoms of constant dry cough and extreme shortness of breathing, he presented to the emergency department in Jordan. He was admitted. His medical history included type 2 diabetes mellitus for the past 4 years. He was a smoker for the past 40 years (approximately 80 packs per year). Six weeks prior to the current presentation, he had been presented with generalised fatigue, diffuse and dull abdominal pain. After thorough investigation, he had been diagnosed with autoimmune periaortitis and had started receiving immunosuppressive therapy with prednisolone 35mg daily. Consequently, his symptoms improved. During follow up, he had developed infected jaw cyst [aetiology not stated]. Due to intensive steroid (prednisolone) therapy, his weight increased (weight gain), and his blood sugar levels fluctuated.

Therefore, the man discontinued steroid (prednisolone) therapy on his own, which led to recurrence of periaortitis symptoms. Subsequently, his steroid therapy was re-initiated and his symptoms resolved. After 8 weeks of intensive steroid therapy, he was admitted to the ICU due to worsening respiratory symptoms secondary to SARS-CoV-2 infection. The prednisolone therapy was considered as risk factor to occurrence of SARS-CoV-2 infection. Subsequently, he developed acute respiratory failure and placed on mechanical ventilation for 10 days. During his ICU stay, prednisolone was switched to IV hydrocortisone 100mg twice a day. Additionally, he received remdesivir along with off label treatment with enoxaparin-sodium [enoxaparin], levofloxacin and lansoprazole for severe SARS-CoV-2 infection. A chest X-ray showed diffuse reticulonodular shadowing observed in middle and lower lung zones bilaterally with mild right-sided pleural effusion. Subsequently, he died due to COVID-19 induced sepsis and acute respiratory failure. Hydrocortisone and prednisolone were considered as risk factors for the worsening of SARS-CoV-2 infection.