An unusual adverse effect of long-term corticosteroid use

Abstract

Conflict of interest: none declared. A 70‐year‐old woman presented with a 16‐month history of multiple tender nodules in the left groin. She had been previously treated with oral antibiotics without improvement. She also had a 30‐year history of unstable asthma, requiring home oxygen, aminophylline and oral prednisolone at doses of between 10 and 30 mg/day. On physical examination, a large fleshy nodule was seen in the left groin, with discharging sinuses, palpable lymph nodes and induration of the surrounding skin (Fig. 1a). Culture of the wound discharge produced a profuse growth of coliforms and Escherichia coli. On magnetic resonance imaging, oedema was seen in the subcutaneous tissue and multiple lymph nodes in the groin, but there was no relevant internal pathology. Results of colonoscopy were normal. The patient was treated with topical antiseptics, oral ciprofloxacin 500 mg twice daily and ascorbic acid 100 mg twice daily for 2 weeks. The nodule gradually reduced in size. A few weeks later, ciprofloxacin was changed to oral trimethoprim 200 mg twice daily because of nausea. The skin continued to improve, and healed completely within 2 months, after which the dose of prednisolone was gradually reduced.