Betamethasone induced Iatrogenic Cushing’s Syndrome in a patient with Systemic Lupus Erythematosus: A Case Report

Background: Cushing’s syndrome (CS) is a disorder characterized by prolonged exposure to elevated glucocorticoid levels. Exogenous or iatrogenic CS is the most common form, frequently associated with long-term corticosteroid therapy, particularly in autoimmune diseases such as systemic lupus erythematosus (SLE). Case Summary: We report a case of a 72-year-old female with a history of SLE and hypertension who developed iatrogenic Cushing’s syndrome following 2–3 months of oral betamethasone therapy. She presented with progressive weight gain, moon facies, truncal obesity, and fatigue. Diagnostic tests confirmed ACTH-independent hypercortisolism with suppressed ACTH levels. Imaging ruled out endogenous etiologies. A structured tapering and withdrawal of betamethasone, along with optimization of azathioprine and initiation of hydroxychloroquine, led to a gradual reversal of Cushingoid symptoms and stabilization of her SLE. Conclusion: This case underscores the need for cautious glucocorticoid use and highlights the utility of steroid-sparing agents in preventing iatrogenic complications. Early recognition and dechallenge are crucial for recovery of HPA axis function and effective autoimmune disease management