Bronchospasmus nach systemischer gabe von methylprednisolon-21- hydrogensuccinat bei oraler toleranz von methylprednisolon

We report the case of a 56-year old woman with a seven year history of bronchial asthma. For treatment of acute asthma attacks, she had repeatedly received intravenous injections of methylprednisolone-21-sodium succinate. After tolerating this therapy on several occasions, she twice developed an acute worsening of her bronchial asthma after intravenous administration of this steroid. In the course of these episodes she had to be intubated and was transferred to the intensive care unit. The patient had received and tolerated methyl-prednisolone orally for years. On intracutaneous testing, a positive skin reaction to methylprednisolone-21-sodium succinate occurred, followed by a bronchospasm. In order to find a therapeutic alternative for the patient, we tested dexamethasone. The intravenous provocation with dexamethasone was well tolerated by the patient.