Corticosteroid-induced bradycardia in multiple sclerosis and maturity-onset diabetes of the young due to hepatocyte nuclear factor 4-alpha mutation: A case report

Figure 1 Brain imaging and clinical course of the patient. A: Axial brain magnetic resonance imaging obtained with T2- fluid-attenuated inversion recovery image and T1-weighted gadolinium enhanced sequences reveals multifocal high signal intensity lesions (white arrows); B: Heart rate and potassium level during hospitalization. Heart rate decreased on day 5 after initiation of intravenous methylprednisolone infusion.

Figure 2 Electrocardiogram of the patient. A: Initial electrocardiogram (ECG) reveals marked sinus bradycardia (heart rate of 35 bpm) with flattening and inversion of T-waves (black arrows), mainly in the precordial leads (V1–V5); B: Follow-up ECG showing normalized heart rate and T-wave configuration after steroid discontinuation. ECG: Electrocardiogram; MRI: Magnetic resonance imaging; FLAIR: Fluid-attenuated inversion recovery image; mPD: Methylprednisolone; bpm: Beats per minute.