A case report of diabetic keto-acidosis post intra-articular steroid injection in patient with type 1 diabetes mellitus: a rare complication.

Background: Intra-articular corticosteroid (IACS) injections are generally considered safe for diabetic patients due to minimal systemic absorption. However, rare complications such as diabetic ketoacidosis (DKA) may still occur. We present a rare case of DKA following IACS, highlighting the need for heightened awareness among clinicians. While IACSs are frequently used for localized joint inflammation and pain relief, systemic complications such as DKA are exceedingly rare. To date, only a handful of case reports have documented this association, making this case a valuable addition to the limited literature. Case Description: We present a case of 76-year-old gentleman who presented to emergency department with DKA on a background of type 1 diabetes mellitus. A thorough history and extensive investigations identified that three days prior to this presentation, the patient had received an IACS injection in his right hip for pain management. The patient was treated for DKA according to the hospital protocol and was reviewed by the Rheumatology and Endocrinology teams who concluded that the probable cause in this case was steroid administration. Conclusions: The patient made a full recovery with no long-term sequelae. This case underscores the importance of recognizing that even localized steroid therapy may have systemic metabolic consequences in diabetic patients. Clinicians should consider proactive monitoring of blood glucose and ketones following IACS injection, particularly in patients with type 1 diabetes.