A cautionary tale of dexamethasone misuse: Unusual co-occurring complications of steroid-induced cardiomyopathy, recurrent cardiogenic shock, and cardioembolic stroke

Rationale: Corticosteroid (dexamethasone) misuse to improve appetite and weight gain is common in low and middle-income (LMICs) countries. Steroid-induced dilated cardiomyopathy is a rare but serious complication associated with corticosteroid (dexamethasone) misuse. Patient concerns: Herein, a case of 20-year-old man who presented to the emergency department (ED) with 6-months history of misuse of Dexamethasone locally called “‘sha ka dwa de”’ in Hausa which roughly translates to “drink and explode.” Dexamethasone misuse was discontinued after achieving the desired weight gain. About two months after discontinuing dexamethasone misuse, the patient developed dyspnea on exertion, cough and easy fatigability. At presentation, he was found to have striae and blood pressure of 90/? Diastolic (mm Hg). Diagnoses: Although, provisional diagnosis of adrenal crisis secondary to steroid withdrawal was entertained. He was commenced on hydrocortisone and adjunctive therapy. Three days later he developed 2 episodes shock which were treated appropriately and shortly thereafter he suffered a stroke. Further review and meticulous physical examination revealed raised jugular venous pressure, displaced and thrusting apex beat, pansystolic murmur in the mitral and tricuspid areas, and fine bi-bisal crepitations. Echocardiography revealed 4-Chamber dilatation, left ventricular (LV) global hypokinesia, severe LV systolic dysfunction, LV intramural thrombus and normal heart valves. A diagnosis of steroid-induced cardiomyopathy complicated by heart failure (HF), recurrent cardiogenic shock and cardioembolic stroke was entertained. Interventions: He was managed for cardiogenic shock, HF, intramural thrombus and stroke as per guideline directed medical therapy. Outcomes: He achieved remarkable improvement and was discharged home asymptomatic of HF with power of 4/5 in the right upper and lower limbs. Lessons: This case highlights the need to educate public and health care practitioners about the devastating cardiometabolic consequences of steroid (dexamethasone) misuse.