Pemphigus and steroid psychosis: a case report and review of literature

Abstract

Introduction: Psychiatric side effects of steroids are often underestimated. The aim of this work is to remind these effects and report one case of steroid-induced psychosis. Observation: Patient aged 64, hospitalized for bullous dermatitis evolving for 3 months. The diagnosis of pemphigus was determined on clinical criteria and histological and immunological examinations and the patient was under steroid therapy at a rate of 2 mg/kg/day or 130 mg/day. Five weeks after starting treatment, he presented disorientation, and emotional irritability. A psycho-organic origin was ruled out before the normality tests including ionogramm blood, brain scan, lumbar puncture and electro-encephalogram. A psychiatric opinion was requested and psychiatric disorders were associated with corticosteroid. The patient was under treatment with antidepressant and neuroleptic psychiatric improvement in the second week of treatment. Discussion: Psychiatric disorders during corticosteroid is poorly understood and often underestimated. Symptomatology is found in type of mood disorders, manic-depressive access, behavioural disorders, insomnia, hallucinations, delirium and dementia. The severity of the psychosis can be classified into 3 levels: euphoria sub-clinical and non-pathological, mood disorders, and manic psychosis and dementia. Patients at risk are those with a history of psychiatric disorders, placed under corticosteroid treatment in the short or long term, or monitored for endocrine disease. The time to onset after starting steroid therapy ranged from 3 weeks to 4 days, mean 4 weeks. Psychiatric symptomatology is reversible under treatment with a neuroleptic withdrawal cortisone. The case of our patient joins the data from the literature. Psychiatric disorders have occurred 4 weeks after the steroids. Conclusion: The psychiatric symptoms including psychosis steroid remain rare and unknown. It is important to identify the onset of psychiatric events that may appear trivial and may lead to fear the installation or the aggravation of these disorders either short or long term.