Pulse Methylprednisolone-Induced Sinus Bradycardia: A Case Report

Corticosteroids have a wide range of uses. The most common adverse side effects of high-dose pulse steroids are hyperglycemia, gastrointestinal intolerance, and psychiatric symptoms. Cardiac arrhythmias have been reported in patients who receive high- dose steroid therapy. Bradycardia is a rare adverse side effect of pulse steroid therapy. We present the case of a 57-year-old male patient who developed symptomatic sinus bradycardia after he received pulse methylprednisolone therapy as treatment for graft-versus-host disease. The patient's pulse steroid therapy was discontinued, and the dose of methylprednisolone was reduced to 100 mg/ day. He was treated conservatively and with close observation; the patient's heart rate increased to 68 beats/min after 1 day, and then to 78 beats/min. The diagnosis of methylprednisolone-induced bradycardia was made after exclusion of other common etiologies of sinus bradycardia. This case report demonstrates the importance of careful cardiovascular monitoring in patients who receive high-dose methylprednisolone because of dose-related cardiovascular risks.