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• W2894903035 abstract "SESSION TITLE: Critical Care 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: We aim to highlight the consequences of short-term, high-dose steroids and the need for investigation of dose and duration for optimization of benefit with minimization of risk through a case of pulmonary cryptococcosis. CASE PRESENTATION: An 84-year-old man with heart failure with preserved ejection fraction presented with acute kidney injury and hypoxic respiratory failure with hemoptysis. He was diagnosed with community-acquired pneumonia (CAP) and acute decompensated heart failure. Respiratory cultures were negative for growth. With no improvement following eight days of diuresis and antibiotics, further work up revealed p-ANCA positive pauci-immune glomerulonephritis. Solumedrol (125mg IV q6H) was then initiated for acute treatment. On day ten he showed respiratory improvement, but he experienced altered mental status and hypoxic/hypercapnic respiratory failure on day thirteen. This resulted in intubation on day fourteen. Bronchoscopy with bronchoalveolar lavage (BAL) showed DAH and grew Cryptococcus neoformans. DISCUSSION: Although chronic steroid therapy is well known to cause immunosuppression, opportunistic infections, and reactivation of latent infections, our case suggests that even short-term, high-dose steroids can result in similar complications. There was recent research published by Waljee et al. that highlighted the potential consequences of short-term steroids even at low doses: sepsis, venous thromboembolism, and fracture; however, it did not study correlation of dose and duration of therapy to risk. This is an area in which there is still a paucity of research. CONCLUSIONS: This case highlights the gap in our knowledge of steroid therapy: In an acute illness that demands short-term steroid use, what steroid dose for which duration balances the benefits of therapy with the risk for opportunistic infection? More research is needed to answer this question as very little was found in literature review to contribute to its answer. Reference #1: Waljee AK, Rogers MAM, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the united states: Population based cohort study. BMJ. 2017;357:j1415. https://www.ncbi.nlm.nih.gov/pubmed/28404617. Accessed Jan 31, 2018. Reference #2: Gallant JE, Chaisson RE, Moore RD. The effect of adjunctive corticosteroids for the treatment of pneumocystis carinii pneumonia on mortality and subsequent complications. Chest. 1998;114(5):1258-1263. https://www.ncbi.nlm.nih.gov/pubmed/9823998. Accessed Jan 31, 2018. Reference #3: Vilchez RA, Irish W, Lacomis J, Costello P, Fung J, Kusne S. The clinical epidemiology of pulmonary cryptococcosis in non-AIDS patients at a tertiary care medical center. Medicine (Baltimore). 2001;80(5):308-312. https://www.ncbi.nlm.nih.gov/pubmed/11552084. Accessed Jan 31, 2018. DISCLOSURES: No relevant relationships by Craig Brown, source=Web Response No relevant relationships by Ashley Choe, source=Web Response No relevant relationships by Kartik Malik, source=Web Response No relevant relationships by Bankim Patel, source=Web Response" @default.
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• W2894903035 date "2018-10-01" @default.
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• W2894903035 title "SECONDARY OPPORTUNISTIC PNEUMONIA AS A CONSEQUENCE OF SHORT-TERM, HIGH-DOSE STEROID THERAPY" @default.
• W2894903035 doi "https://doi.org/10.1016/j.chest.2018.08.218" @default.
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