Angel or devil? Speech disorder after dexamethasone injection for sore throat

Introduction: The use of a single-dose of intramuscular (IM) dexamethasone in emergency department (ED) is a commonly employed practice. Along with its anti-inflammatory and immunomodulatory effects, dexamethasone use has considerable adverse effects and complications that affect almost all body systems. This paper describes a middle-aged patient receiving IM injection of the agent followed by a serious temporary neurological deficit.

Case report: A 48-year-old male patient presented to the ED due to cough, sore throat, fever, and malaise lasting for three days. In the medical history, the patient did not reveal any chronic illness, allergies or regular drug use. After complete evaluation, an IM injection of dexamethasone (8 mg vial) was administered to the patient as a treatment in the green (low acuity) area of the ED. While the neurological examination of the patient was completely normal on admission; dysarthria, bilateral dysmetria, and truncal ataxia ensued within 15 minutes after the IM injection. No pathological findings were detected in the laboratory and radiological work up. The signs and symptoms subsided and returned to normal within three-hour follow-up.

Conclusion: Acute neurological complications, although very rare, can follow IM steroid injections. Patients receiving IM dexamethasone need to be observed for a while even if they are asymptomatic. Causal relationships need to be highlighted with well-designed prospective studies.

Dexamethasone; Dysarthria; Dysmetria; Ataxia; Side effect; Adverse effect; Emergency

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