Mania related with corticosteroid withdrawal in Behçet’s disease: a case report

Corticosteroids are routinely used in Behçet’s disease, which is classified in autoimmune disorders. In steroid treatment, psychiatric side effects can occur as well as systemic side effects like osteoporosis, glaucoma, and cataract. In literature, it has been reported that affective symptoms are possible side effects of corticosteroids for a long time. Especially reducing the dose after a long term and high dose corticosteroid treatment or abrupt discontinuation can cause corticosteroid withdrawal syndrome and anxiety and restlessness were reported in addition to delirium and mania. In this case, with no history of a psychiatric disorder, the patient with diagnosis of uveitis was prescribed prednisolone 60 mg per day. After ten-day treatment, dosage had decreased to 30 mg per day for ten days and subsequently discontinued. Manic symptoms characterized by sleeplessness, logorrhea, irritability, increased sexual pursuits had started six days after dosage reduction and increased one day after termination of prednisolone treatment. There was no organic pathology in cranial MRG and EEG, which could be a reason for manic symptoms. The clinical presentation was interpreted as a manic episode related with steroid withdrawal. After three weeks of lithium 900 mg per day and olanzapine 10 mg per day, manic symptoms had decreased. By the end of two months of follow up treatment, no recurrence, so olanzapine was stopped on third month, lithium was discontinued step by step on ninth month because of planned pregnancy. During one-year clinic visits, there was no mood disorder. This case suggests that psychiatric symptoms could appear in withdrawal syndromes that appear with abrupt reduction and/or discontinuation as well as short-time or prolonged corticosteroid treatments.