Allergic
hypersensitivity reactions are a rare adverse effect of
corticosteroids. Previous reports have identified patients who developed symptoms of
urticaria,
dyspnea,
hypotension,
bronchospasm, and
angioedema occurring within minutes to an hour after
corticosteroid administration. A 35-year-old woman is described who developed an atypical reaction of isolated
macroglossia after receiving intravenous
methylprednisolone sodium succinate for myasthenic crisis.
Macroglossia was identified on day 2 of
therapy and worsened through day 5. On day 5, she was transitioned to
prednisone 50 mg daily administered by
feeding tube. Tongue swelling improved by day 7 and on day 10, the patient was extubated. The patient required reintubation due to
stridor, but received a
tracheostomy and was weaned off
mechanical ventilation by day 15. The reaction was not confirmed with skin-prick tests, intradermal tests, or a
drug rechallenge; however, she had previously received and tolerated all other drugs administered during this time. Due to the timing of administration and onset of symptoms, we feel this
adverse drug reaction was likely due to administration of
methylprednisolone. Applying the Naranjo
adverse drug reaction probability scale to this case, a score of six was obtained, indicating a probable association between the administration of
methylprednisolone and the development of
macroglossia. As intravenous
corticosteroids are often used in the treatment of
allergic reactions, they may be overlooked as a cause of
macroglossia and other
allergic reactions; therefore, practitioners need to be aware of the possibility of this adverse effect secondary to
corticosteroid administration. In the event of
methylprednisolone sodium succinate-induced
macroglossia, alternative nonesterified
corticosteroids, such as
dexamethasone or
prednisone, should be considered if continuation of
therapy is required.