Reactions 1871, p258 - 4 Sep 2021

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Reactions 1871, p258 - 4 Sep 2021

Methylprednisolone/prednisone

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Worsening of COVID-19 pneumonia: case report

An 80-year-old woman developed worsening of COVID-19 pneumonia following treatment with methylprednisolone and prednisone for relapsed ulcerative colitis (UC) [durations of treatments to reaction onset not stated; not all dosages stated].

The woman, who had a history of UC for 3 years in maintenance therapy with mesalazine [mesalamine], presented to a clinic in Italy on 12 February 2020, due to fever and bloody diarrhoea for the previous 7 days. Investigations revealed severe anaemia and elevated CRP. She was diagnosed with severe UC relapse. She was then treated with IV methylprednisolone 40 mg/day.

Consequently, her condition improved significantly. However, on day 4, she developed fever of 39°C and dry cough. Chest X-ray revealed bilateral pneumonia, which was confirmed by chest CT scan. Her nasopharyngeal swabs tested positive for SARS-CoV-2 infection. She was diagnosed with COVID-19 pneumonia and received off-label treatment with lopinavir/ritonavir and hydroxychloroquine, in addition to non-invasive ventilation. Her therapy with methylprednisolone was switched to oral prednisone with an accelerated tapering. Initially her condition improved. However, COVID-19 pneumonia worsened, which was considered to be associated with methylprednisolone and prednisone. After 14 days of hospitalisation, she died of COVID-19 pneumonia. She was receiving prednisone 25mg daily at the time of death. Considering a COVID-19 incubation time of up to 14 days, it is possible that she was already harbouring SARS-CoV-2 when corticosteroids were started.

Mazza S, et al. A fatal case of COVID-19 pneumonia occurring in a patient with severe acute ulcerative colitis. Gut 69: 1148-1149, No. 6, Jun 2020. Available from: URL:

http://doi.org/10.1136/gutjnl-2020-321183 803592330