Aguesia, rash, HTN following LESI

[Pain Applicant1]

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Performed a well tolerated, uncomplicated LESI on an otherwise healthy 48 yo F. 1-2 days following procedure pt came down with facial swelling, roundness and flushing, HTN, and tachycardia. Visited ED and told it was allergy to dye, treated with benadryl and steroid. Symptoms with minimal intermittent improvement. One week later pt with itchy rash on face and in throat, round face, lethargy, fatigue, and continued aguesia. Any thoughts on or experiences with this?

I think it might be an iatrogenic cushingoid reaction to the steroid. I'm sending her to endo to help me evaluate her and am going to contact the pharmacy who whipped up the PF kenalog.

Good news is back pain has improved 🙂

 

[lobelsteve]

Sounds much more likely a steroid reaction and not an allergy.
Watchful waiting and Endo consult appears perfect.

 

[mille125]

Sounds much more likely a steroid reaction and not an allergy.
Watchful waiting and Endo consult appears perfect.

I agree. This really looks like a steroid reaction.

 

[Pain Applicant1]

Thanks for the responses, very reassuring. No retroviral agents but good thought. PPI and gabapentin only.

 

[Tenesma]

i bet adrenal insufficiency...

i had a woman get Cushingoid w/ similar reaction for 3 months after a one-time use of Advair... however, she was on anti-retro-virals and was also hydrocortisone dependent.