Unmasking a rare entity: Steroid-induced diabetic ketoacidosis in a patient with sjogren syndrome and uncontrolled diabetes: A case report

A 54-year-old woman with Sjogren Syndrome and type 2 diabetes developed diabetic ketoacidosis (DKA) following IV methylprednisolone treatment. Though corticosteroids are known to elevate blood glucose, steroid-induced DKA remains exceptionally rare, with only six published cases in PubMed-indexed literature. Despite standard interventions—IV fluids and insulin—her hyperglycemia persisted, resolving only after discontinuing the steroid. This severe reaction likely arose from overlapping mechanisms: increased insulin resistance, impaired insulin secretion, and heightened hepatic glucose production. The case highlights the critical need for vigilant glucose monitoring in patients with comorbidities receiving steroids, particularly when conventional therapies fail. Early recognition and discontinuation of triggering agents may be pivotal in preventing life-threatening complications. • We present one of few reported instances of steroid-induced diabetic ketoacidosis. • A 54-year-old woman with Sjogren S developed severe DKA after IV methylprednisolone. • Stresses monitoring and management in patients with autoimmune diseases and diabetes.