Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7415-7421
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7415
Corticosteroid-induced bradycardia in multiple sclerosis and maturity-onset diabetes of the young due to hepatocyte nuclear factor 4-alpha mutation: A case report
Sung-Yeon Sohn, Shin Yeop Kim, In Soo Joo
Sung-Yeon Sohn, Shin Yeop Kim, In Soo Joo, Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon 16499, South Korea
Author contributions: Sohn S-Y conceptualized, investigated and wrote the manuscript; Kim SY investigated and reviewed the manuscript; Joo IS supervised, reviewed and edited the manuscript.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: In Soo Joo, MD, Professor, Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, No.164 World Cup Road, Yongtong District, Suwon 16499, South Korea. isjoo@ajou.ac.kr
Received: September 24, 2021
Peer-review started: September 24, 2021
First decision: March 3, 2022
Revised: April 8, 2022
Accepted: June 4, 2022
Article in press: June 4, 2022
Published online: July 26, 2022
Processing time: 289 Days and 22.2 Hours
Abstract
BACKGROUND

Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis (MS). Although steroid administration is generally well-tolerated, cases of cardiac arrhythmia have been reported. Herein, we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration. We also present plausible explanations for the abnormalities observed in this patient.

CASE SUMMARY

An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission. Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy. The initial laboratory results were consistent with those of type 2 diabetes. Brain magnetic resonance imaging revealed multifocal, non-enhancing, symptomatic lesions and multiple enhancing lesions. She was diagnosed with MS and maturity-onset diabetes of the young. Intravenous methylprednisolone was administered. On day 5 after methylprednisolone infusion, marked bradycardia with T-wave abnormalities were observed. Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha (HNF4A) gene mutation. Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia. Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.

CONCLUSION

Corticosteroid-induced bradycardia may have a significant clinical impact, especially in patients with comorbidities, such as HNF4A mutations.

Keywords: Steroids; Bradycardia; Multiple sclerosis; Maturity-onset diabetes of the young; Hepatocyte nuclear factor 4-alpha; Case report

Core Tip: Corticosteroid administration may cause cardiac arrhythmias including severe bradycardia. The accompanying T-wave abnormalities may provide clues regarding the pathophysiology of corticosteroid-induced bradycardia. This case report highlights the need for clinical vigilance during high-dose corticosteroid administration, particularly in potentially vulnerable patients harboring genetic variants.