AJR 2002; 178:766-767
© American Roentgen Ray Society
Premedication Before IV Contrast-Enhanced CT Resulting in Steroid-Induced Psychosis
Benoît Mesurolle,
Michèle Ariche and
David Cohen
Institut Gustave-Roussy F-94805 Villejuif Cedex, France
Groupe Hospitalier
Pitié-Salpétrière
F-75013 Paris, France
We read with interest the article by Freed et al.
[1], in the June 2001 issue of
the American Journal of Roentgenology on the adverse reactions to
low-osmolar contrast media after steroid premedication. We would like to take
the opportunity to report an unusual adverse effect of steroid premedication
that we encountered in a young female patient with bipolar disorder. A
13-year-old girl was brought to a psychiatric unit with a diagnosis of maniac
episode with psychotic features. Chlorpromazine and tropatepine were started,
and carbamazepine was added on day 14. On day 16, symptoms improved
dramatically. Electroencephalography and unenhanced CT of the head showed no
abnormalities. Because the patient had a history of adverse reaction to
contrast material, radiologists prescribed a 3-day treatment using
methyl-prednisolone (32 mg/day) and ranitidine (300 mg/day) from day 18 to day
20, before she underwent contrast-enhanced CT of the head. Her psychiatric
symptoms suddenly reappeared on day 19, and they were more severe than
initially, including extreme agitation and mental confusion. Because the
patient had shown no improvement, all drugs were discontinued on day 26. A new
treatment was started that used both haloperidol and lithium carbonate. Her
manic symptoms improved from day 31, and the patient was euthymic at discharge
2 weeks later.
In this case, according to the French method used for assessment of
unexpected or toxic drug reaction
[2], it is likely that the
recurrence of manic symptoms in this patient with bipolar disorder was a
consequence of the methylprednisolone or ranitidine. Published data support
the role of the glucocorticoid, because ranitidine has not been reported as a
cause of manic reaction [3].
The exacerbation of maniac symptoms following exogenous glucocorticoid
administration is not a new phenomenon. It has been reported in the adult
literature, but never in a case of short-term premedication before
contrast-enhanced radiologic examinations. On one hand, many studies report
the frequency and nature of adverse reactions to contrast media even after
steroid premedication. On the other hand, only anecdotal articles report
adverse or unusual effects of steroid premedication before contrast-enhanced
CT. Wong et al. [4] reported a
case of resolution of lymphadenopathy in a patient with lymphoma, after
short-term steroid premedication.
To the best of our knowledge, this psychiatric complication after steroid
premedication has not been reported previously. This case shows that even
short-term doses of steroid may have a significant adverse effect on patients
with a history of mood disorders. Caution is advised when instituting steroid
premedication in these patients. Such premedication may induce exacerbation of
mood symptoms, even when patients are under mood stabilizers
[5].
References
-
Freed KS, Leder RA, Alexander C, DeLong DM, Kliewer MA.
Breakthrough adverse reactions to low-osmolar contrast media after steroid
premedication. AJR
2001;176:1389
-1392[Abstract/Free Full Text]
-
Moore N, Biour M, Paux G, et al. Adverse drug reaction monitoring:
doing it the French way. Lancet
1985;2:1056
-1058[Medline]
-
Long TD, Kathol RG. Critical review of data supporting affective
disorder caused by nonpsychotrophic medication. Ann Clin
Psychiatry 1993;5:259
-270[Medline]
-
Wong TZ, Levine JD, Safer M, Jones EL. Steroid premedication before
IV contrast-enhanced CT resulting in resolution of lymphadenopathy.
AJR
1998;170:218
-219[Medline]
-
Siegel FP. Lithium for steroid-induced psychosis. N Eng
J Med 1978;299:155
-156[Medline]
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