Adverse reaction to prednisone in a patient with systemic lupus erythematosus

Oral corticosteroids are the main therapeutic choice for systemic lupus ery thematosus (SLE). Adverse reactions to systemic corticosteroids rarely occu r and the etiology is unclear in most cases. A 14-year-old girl with newly diagnosed SLE developed a pruritic bullous eruption while on prednisone. Th e patient had been treated successfully in the hospital with intravenous me thylprednisolone. In preparation for discharge, the steroid preparation was changed to prednisone to which the patient reacted with a development of n ew crops of bullous lesions. Skin biopsy specimens of lesional areas showed a bullous eruption consistent with erythema multiforme. The patient underw ent immediate and delayed hypersensitivity tests. Intradermal and patch tes ts to liquid prednisone were positive. The patient was discharged on oral m ethylprednisolone and has not had recurrence of the skin lesions. In conclu sion, a case of prednisone sensitivity in a patient with SLE is presented h ere. An alternative preparation, methylprednisolone, was used to successful ly treat her underlying condition.