ANAPHYLACTIC SHOCK-INDUCED BY INTRAARTICULAR INJECTION OF METHYLPREDNISOLONE ACETATE

There are numerous reports of hypersensitivity reactions to corticoste roids. However, cases of anaphylactic shock after intraarticular injec tion of corticosteroids are exceedingly rare. We describe a case of an aphylaxis in a 31-year-old woman after intraarticular injection of syn thetic methylprednisolone acetate, Immediately after injection she dev eloped sneezing, angioedema, tachycardia, and marked hypotension, She responded promptly to treatment with subcutaneous epinephrine. She had received uneventfully one intraarticular injection of the same compou nd 4 years earlier. Intradermal skin testing showed strong reactivity to methylprednisolone acetate suspension, moderate reactivity to hydro cortisone, and weak reactivity to betamethasone. Tests with dexamethas one, triamcinolone, lidocaine, latex and nonsteroid constituents of th e injected suspension including polyethylene glycol, polysorbate 80, m ono and dibasic sodium phosphate, and myristyl-gamma-picolinium chlori de were negative, This patient had developed anaphylaxis due to methyl prednisolone acetate alone. Although such events are very rare, it is advisable to keep injectable epinephrine in the offices of rheumatolog ists.