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      Ominous triad triggered by high-dose glucocorticosteroid therapy

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          Abstract

          Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis—a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy. Our patient’s condition was further aggravated by a circulatory shock, haemodynamic relevant bleeding from a duodenal ulcer and psychotic symptoms. In the intensive care unit, intravenous insulin infusion, fluid resuscitation, catecholamine support, electrolyte supplementation, endoscopic haemoclipping and antibiotic and antipsychotic treatment were administered, leading to a continuous improvement of the patient’s health state.

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          Author and article information

          Journal
          BMJ Case Rep
          BMJ Case Rep
          casereports
          bmjcasereports
          BMJ Case Reports
          BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
          1757-790X
          2017
          18 June 2017
          : 2017
          Affiliations
          [1 ] departmentDivision of Internal Medicine , Hospital Tiefenau, Inselgruppe AG, University of Bern , Bern, Switzerland
          [2 ] departmentDivision of Intensive Care , Hospital Tiefenau, Inselgruppe AG, University of Bern , Bern, Switzerland
          Author notes
          [Correspondence to ] Dr Thomas Zueger, thomas.zueger@ 123456spitaltiefenau.ch
          Article
          PMC5534994 PMC5534994 5534994 bcr-2017-220328
          10.1136/bcr-2017-220328
          5534994
          28630246
          © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
          Categories
          Article
          Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
          1525
          Female
          51-70 years
          White
          Europe (West)
          Case Report

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