Steroid as double edged sword; a catastrophic event in the rural part of Nepal

INTRODUCTION AND IMPORTANCE: Cushing's syndrome is a rare condition caused by the long-term glucocorticoid exposure. The clinical picture is variable in severity and presentation. All form of steroid use (parenteral, topical, inhalational as well as additive in herbal and other formulations) are responsible for causing iatrogenic Cushing syndrome. CASE: We present a case of 59 year male from rural Nepal who initiated prednisolone 10mg per day for trivial joint pain over the counter (OTC) for 14 years presented with acute cellulitis of arm and long term changes of steroid overuse. This study is directed to alarm the importance of medical history review and management. CLINICAL FINDINGS AND INVESTIGATIONS: Patient had features of florid Cushing syndrome and joint line tenderness of bilateral knee along with lumbar vertebral tenderness.ACTH level, Abdominal ultrasonography, imaging of knee and thoracolumbar spine was sent for diagnosis. INTERVENTION AND OUTCOME: Patient was manged with analgesics, antibiotics, alternate day dressings and referred to orthopaedics for further management of osteoarthritic changes. CONCLUSION: To prevent such catastrophic event topical steroids and their mixtures must be sold as "prescription-only" medications and physicians must take detailed history prior to management and correct the irrational use of drugs like Steroids.