E3 PreliminaryPreliminaryPEM not requiredCase-ControlPeer-reviewedReviewed
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Hypertension and Severe Hypokalemia Associated With Oral Ingestion of Topical Hydrocortisone Cream.
Saha, Arunava, Balakrishnan, Suryanarayanan, Trivedi, Nitin et al. · AACE clinical case reports · 2023 · DOI
Quick Summary
This case report describes a woman with chronic fatigue syndrome who accidentally poisoned herself by swallowing topical hydrocortisone cream as a replacement for prescription prednisone. She developed dangerously high blood pressure and a severe drop in potassium levels, which can cause life-threatening heart problems. The key lesson is that over-the-counter medications can cause serious harm if used incorrectly, even when applied to skin.
Why It Matters
ME/CFS patients often experience medication management challenges and may self-adjust treatments when experiencing worsening symptoms. This case illustrates how even seemingly benign over-the-counter products can cause life-threatening complications when misused, highlighting the importance of patient education and careful medication counseling in vulnerable populations.
Observed Findings
Severe hypokalemia (1.5 mEq/L) developed after one month of twice-daily topical hydrocortisone cream ingestion
Severe hypertension (232/110 mmHg) and generalized weakness were presenting symptoms
Serum cortisol elevated at 61.5 μg/dL with suppressed ACTH, indicating exogenous corticosteroid source
Creatine kinase elevated at 1864 IU/L, indicating muscle damage
Cortisol normalized to 11 μg/dL and potassium to 4.1 mEq/L within 24 hours of discontinuation and supportive treatment
Inferred Conclusions
Topical hydrocortisone cream, when ingested, can cause systemic corticosteroid toxicity due to its mineralocorticoid properties, unlike oral prednisone
OTC medication misuse can produce acute life-threatening electrolyte and cardiovascular complications
Rapid clinical improvement follows cessation of the offending agent and electrolyte repletion
Patients discontinuing long-term corticosteroids require close medical supervision to prevent unsafe self-treatment attempts
Remaining Questions
What proportion of patients discontinuing long-term corticosteroids attempt unsafe self-replacement with OTC preparations?
What This Study Does Not Prove
This single case report does not establish the incidence or prevalence of hydrocortisone cream toxicity in any population. It does not prove that ME/CFS patients are more susceptible to corticosteroid toxicity than others, nor does it establish causation between ME/CFS and poor medication decisions—the patient's actions resulted from discontinuation of prescribed therapy without medical supervision.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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