Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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A case of steroid-induced psychosis in a child having nephrotic syndrome with toxic epidermal necrolysis

신증후군 환아에서 발생한 독성표피괴사용해 치료를 위해 사용된 고용량 스테로이드로 인한 정신질환 1례

  • Kim, Sae Yoon (Department of Pediatrics, Yeungnam University College of Medicine) ;
  • Lee, Jae Min (Department of Pediatrics, Yeungnam University College of Medicine) ;
  • Park, Yong Hoon (Department of Pediatrics, Yeungnam University College of Medicine)
  • 김세윤 (영남대학교 의과대학 소아과학교실) ;
  • 이재민 (영남대학교 의과대학 소아과학교실) ;
  • 박용훈 (영남대학교 의과대학 소아과학교실)
  • Received : 2009.09.15
  • Accepted : 2009.12.10
  • Published : 2010.03.15
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Abstract

Toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome (SJS) are rare, life-threatening mucocutaneous -diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.

독성표피괴사용해(TEN)와 스티븐-존슨 증후군(SJS)은 약물이나 감염에 의해 발생하는 피부점막을 침범하는 드물지만 치명적인 질병이다. 스테로이드는 TEN의 치료에 많이 이용되어왔지만, 아직까지도 논쟁중이다. 스테로이드에 의한 정신과적 영향은 두통, 불면증, 우울증, 심리질환 등이 있다. 스테로이드에 의한 정신질환에서 치료는 스테로이드의 감량 또는 중단이고, 항정신성 약물을 투여한다. 신증후군으로 진단된 11세 남아에서 스테로이드 치료 후 관해상태에서 유지치료를 시행하고 있던 중에 TEN이 발생하였다. 저자들은 이 환아에서 치료목적으로 투여한 고용량 스테로이드 정맥주사로 인해 정신질환이 동반되었고, 이후 스테로이드 감량과 항정신성 약물과 면역글로불린으로 증상이 호전되는 것을 경험하여 이를 보고하는 바이다.

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