ArticleInternational medical case reports journal2026
Anaphylaxis Following Intravenous Methylprednisolone Sodium Succinate: A Case Report.
Article in International medical case reports journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Immediate hypersensitivity to systemic corticosteroids is rare but potentially life-threatening, and it may be overlooked when the cardiovascular presentation is atypical. Identifying the responsible determinant, whether the corticosteroid molecule, a solubilizing ester, or a formulation excipient, is often difficult. Case Presentation: A 45-year-old woman with rheumatoid arthritis developed a generalized pruritic, erythematous, raised eruption, dyspnea, hypoxemia, bradycardia, and reduced consciousness within 5 minutes of starting intravenous methylprednisolone sodium succinate 250 mg. The infusion was stopped, and symptoms resolved after intramuscular epinephrine 0.4 mg. Approximately 7 hours later, because the reaction was considered unlikely to be allergic, the same formulation was re-administered in two graded steps (25%, then 75%) under continuous monitoring and direct physician supervision. This high-risk re-exposure after clinically convincing anaphylaxis reproduced the cutaneous and respiratory features, again with bradycardia (heart rate 51 beats/min) and hypoxemia (oxygen saturation 88%), and required intramuscular epinephrine 0.3 mg, an intravenous antihistamine, oxygen, and a bronchodilator. Serum tryptase and formal allergy testing were not obtained. She later reported tolerating oral prednisolone, with no recurrent symptoms during 3 months of follow-up. Conclusions: Recurrence on re-exposure supports anaphylaxis to the administered methylprednisolone formulation, but without confirmatory testing the reaction cannot be attributed to methylprednisolone itself, the succinate ester, or an excipient. This patient-safety case shows that bradycardia does not exclude anaphylaxis; that a graded challenge is a diagnostic test, not desensitization, and is not a recommended strategy after convincing anaphylaxis; and that the exact implicated formulation should be documented instead of a nonspecific steroid-allergy label.
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