Reactions Weekly | 2021
Methylprednisolone
Abstract
Lack of efficacy: case report A 63-year-old woman exhibited lack of efficacy while receiving methylprednisolone for catastrophic antiphospholipid syndrome (CAPS). The woman, who had various comorbidities, presented with acute right lower limb pain accompanied by coldness and numbness. Examination revealed a cold, pale right lower limb with reduced sensation and non-palpable pulses over the right femoral, popliteal, dorsalis pedis, and posterior tibialis. CT Angiogram of the bilateral lower limbs showed a long segment thrombosis in the mid and distal right superficial femoral artery. An acute right lower limb ischaemia was diagnosed. She was treated with heparin and underwent a right lower limb femoral embolectomy. Postoperatively, the right lower limb pulses were palpable but became absent again on day two. A repeat CT aorta demonstrated a short segment mural thrombus at the infra-renal abdominal aorta with minimal mural thrombus at the bilateral common iliac and common femoral arteries. The team proceeded with a bilateral femoral embolectomy for worsening symptoms. However, the procedure was complicated with hypotension requiring inotropic support and ICU admission. Subsequently, methylprednisolone [dosage and route not stated] was given for probable CAPS. Despite treatment, she rapidly deteriorated and developed renal failure (lack of efficacy). She required invasive ventilation, ultimately succumbing to her illness. Features of peripheral blood film sent during admission were suggestive of acute leukaemia. The final diagnosis was probable CAPS precipitated by acute leukaemia.