Vasculitis and Steroid Psychosis: A Case Report and Review of Literature

Corticosteroids have become the cornerstone of therapy for many pathologies such as vasculitis. Steroid psychosis is a known complication of corticosteroids therapy, although infrequent. We describe a case of psychosis secondary to corticosteroids in a 69-year-old man with large-vessel vasculitis without previous history of psychiatric pathology. He was diagnosed with large-vessel vasculitis and the treatment started with prednisone 1 mg/kg/day. One week later, the patient presented with behavior change: emotional lability, disorientation and aggressiveness. The symptoms worsened for hallucinatory activity and cognitive deficit. After exclusion of other causes, the diagnosis of psychosis secondary to corticosteroids was assumed. It was decided to wean corticosteroids and start new therapy with methotrexate and tocilizumab and introduction of antipsychotic therapy. The patient had a good outcome with disease remission and had no further neuropsychiatric symptomatology. Systemic corticosteroids are widely used, sometimes with a low concern of its potential adverse effects. So it is important that physicians are aware of the potential for their adverse effects and the need to monitor disease activity and drug toxicity.