Corticosteroids rank at the first place among the most commonly used immunosuppressive agents in the rheumatology practice. Although their conventional adverse effects including hyperglycemia, hypertension, hyperlipidemia, and osteoporosis are well-recognized and managed, steroid-induced cardiac arrhythmias are known to a lesser extent. In this regard, steroid-associated bradycardia is rarely expected and not very well known. Reported cases of steroid-associated bradycardias in the literature predominantly have emerged during the course of intravenous high-dose (pulse) methylprednisolone (MP) administrations. In this paper, we report a patient who developed sinus bradycardia following 52 mg of oral MP administration, improved once the drug was discontinued but repeated with the re-administration. Hence, the patient was shifted to prednisolone (PRED), and again suffered bradycardia which recovered upon dose reduction. Presenting this case along with other similar rare cases in the literature, our aim is to draw attention of fellow rheumatologists, who widely use steroids, to bradycardia—a rare and dose-dependent side effect of steroids.
This is a preview of subscription content, log in to check access.
Study concept and design: DUC, EB, and CK; analysis and interpretation of data: DUC, EB, and CK; drafting of the manuscript: DUC; critical revision of the manuscript for important intellectual content: DUC, EB, and CK; study supervision: DUC, EB, and CK.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from our patient.
Vasheghani-Farahani A, Sahraian MA, Darabi L, Aghsaie A, Minagar A (2011) Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multiple sclerosis. J Neurol Sci 309:75–78PubMedCrossRefGoogle Scholar
Ohshima M, Kawahata K, Kanda H, Yamamoto K (2017) Sinus bradycardia after intravenous pulse methylprednisolone therapy in patients with systemic lupus erythematosus. Mod Rheumatol 1:1–4 (Epub ahead of print)CrossRefGoogle Scholar
Stroeder J, Evans C, Mansell H (2015) Corticosteroid-induced bradycardia: case report and review of the literature. Can Pharm J (Ott) 148:235–240CrossRefGoogle Scholar
Kundu A, Fitzgibbons TP (2015) Acute symptomatic sinus bradycardia in a woman treated with pulse dose steroids for multiple sclerosis: a case report. J Med Case Rep 24;9:216PubMedPubMedCentralCrossRefGoogle Scholar
Taylor MR, Gaco D (2013) Symptomatic sinus bradycardia after a treatment course of high-dose oral prednisone. J Emerg Med 45:e55–e58PubMedCrossRefGoogle Scholar
Marinov M, Fuessel MU, Unterrainer AF (2013) Bradycardia after dexamethasone for postoperative nausea and vomiting prophylaxis during induction of anaesthesia. Br J Anaesth 111:1025–1026PubMedCrossRefGoogle Scholar
John PR, Khaladj-Ghom A, Still KL (2016) Bradycardia associated with steroid use for laryngeal edema in an adult: a case report and literature review. Case Rep Cardiol 2016:9785467PubMedPubMedCentralGoogle Scholar
Hasan AQ, Al-Khazraji A (2016) Corticosteroids-induced bradycardia: a case report and literature review. J Med Sci Clin Res 4:1566–11569Google Scholar
Soni R, Kumar R, Debnath J (2017) Hydrocortisone induce bradyarrhythmias: a case report. Int J Sci Rep 3:13–14CrossRefGoogle Scholar
Li J, Azaad MA, Li Y, Zhang Q (2017) Sinus bradycardia rare but expected complications of chemo regimen involving dexamethasone: case report. Open J Blood Dis 7:47–50CrossRefGoogle Scholar
Jain R, Bali H, Sharma VK, Kumar B (2005) Cardiovascular effects of corticosteroid pulse therapy: a prospective controlled study on pemphigus patients. Int J Dermatol 44:285–288PubMedCrossRefGoogle Scholar
Al Shibli A, Al Attrach I, Hamdan MA (2012) Bradycardia following oral corticosteroid use: case report and literature review. Arab J Nephrol Transplant 5:47–49PubMedGoogle Scholar
Orgun A, Gursu HA, Cetin II (2018) Wolff–Parkinson–White syndrome presenting with steroid-induced bradycardia in a patient with acute rheumatic fever. Cardiol Young 2:1–3Google Scholar
Domínguez-Pinilla N, Del Fresno-Valencia MR, de Inocencio Arocena J, Enríquez Merayo E (2014) Sinus bradycardia secondary to the use of pulse corticosteroids [article in Spanish]. An Pediatr (Barc) 80:331–332CrossRefGoogle Scholar
van der Gugten A, Bierings M, Frenkel J (2008) Glucocorticoid-associated Bradycardia. J Pediatr Hematol Oncol 30:172–175PubMedCrossRefGoogle Scholar
Akikusa JD, Feldman BM, Gross GJ, Silverman ED, Schneider R (2007) Sinus bradycardia after intravenous pulse methylprednisolone. Pediatrics 119:e778–e782PubMedCrossRefGoogle Scholar
Küçükosmanoğlu O, Karabay A, Ozbarlas N, Noyan A, Anarat A (1998) Marked bradycardia due to pulsed and oral methylprednisolone therapy in a patient with rapidly progressive glomerulonephritis. Nephron 80:484PubMedCrossRefGoogle Scholar
Berkenbosch JW, Tobias JD (2003) Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med 4:203–205PubMedCrossRefGoogle Scholar
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245PubMedCrossRefGoogle Scholar