SHM Converge Scientific Abstract ePoster Gallery-Adverse Outcomes in a Farmer With Self-Injection of Veterinary Corticosteroids

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This case describes a 60-year-old farmer with rheumatoid arthritis, antiphospholipid syndrome, atrial fibrillation, CHF, COPD, hypertension, osteoporosis, and prior pulmonary embolism who presented with weakness and dyspnea. Family history and rheumatology records revealed that he was non-compliant with prescribed therapy and had been self-injecting livestock glucocorticoids because he believed he had rheumatoid vasculitis and was dissatisfied with his treatment.<br /><br />On arrival, he was hypotensive and tachycardic with severe metabolic abnormalities, including marked hyperglycemia, acute kidney injury, hyperkalemia, metabolic acidosis, and elevated lactate. He was admitted to the MICU with sepsis and diabetic ketoacidosis concerns. Blood cultures grew MSSA, and he was treated with cefazolin. Despite initial improvement and transfer out of the ICU, he later developed lower-extremity weakness. Further workup showed numerous brain abscesses consistent with septic emboli, pulmonary emboli on chest CT, and worsening cardiopulmonary instability. He developed atrial fibrillation with rapid ventricular response, hypotension, respiratory failure requiring intubation, bradycardia requiring atropine, and ultimately multiorgan failure. His family transitioned him to comfort care.<br /><br />The report emphasizes that corticosteroids are commonly used for rheumatoid arthritis, but prolonged or high-dose use increases risks such as immunosuppression, adrenal insufficiency, and osteoporosis. In this unusual case, self-administration of veterinary steroids likely contributed to severe bacteremia and catastrophic complications.<br /><br />The authors highlight the dangers of access to nonprescription veterinary medications, the need for patient education about rheumatoid arthritis and appropriate treatment, and the importance of early recognition of infection and steroid-related harm.

Asset Subtitle

Gifty D. Marfowaa

Meta Tag

Author List Amer Al Homssi, Gabriel Lira, Gifty D. Marfowaa, Pinky Jha

Category Clinical Vignettes

Concept Rheumatoid Arthritis

Concept Corticosteroids

Concept Adverse Effect

Concept Immunosuppression

Concept Veterinary Glucocorticoid

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Gifty D. Marfowaa

Track Adult

Keywords

rheumatoid arthritis

self-injection

veterinary glucocorticoids

MSSA bacteremia

septic emboli

brain abscesses

diabetic ketoacidosis

adrenal insufficiency

immunosuppression

multiorgan failure

Rheumatoid Arthritis

Corticosteroids

Adverse Effect

Immunosuppression

Veterinary Glucocorticoid