Can 40 mg of prednisolone (corticosteroid) cause septic shock and death in a 73 kg woman with a complaint of fever, but normal temperature, normal complete blood count (CBC) of 9000 cells/μL, normal peripheral smear, and negative typhidot test?

Prednisolone 40mg Does Not Cause Septic Shock in a Patient with Normal Vital Signs and Laboratory Values

Prednisolone 40mg is highly unlikely to cause septic shock or death in a 73kg woman with subjective fever but normal temperature, normal CBC (9000 cells/μL), normal peripheral smear, and negative typhidot test.

Understanding Prednisolone and Sepsis Risk

Prednisolone is a corticosteroid that has immunosuppressive effects, but at a standard dose of 40mg in a patient without evidence of active infection, it does not directly cause septic shock. Here's why:

1. Dose Consideration:

   • 40mg of prednisolone is a moderate therapeutic dose, not an excessive one for a 73kg adult
   • This dose is well below the high-dose corticosteroid regimens (equivalent to 200-300mg hydrocortisone) used in critical care settings 1

2. Patient's Clinical Status:

   • The patient has:
     • Normal temperature (despite subjective fever)
     • Normal WBC count (9000 cells/μL)
     • Normal peripheral smear
     • Negative typhidot test
   • These findings suggest absence of active infection or sepsis

Corticosteroids and Infection Risk

While corticosteroids like prednisolone can increase susceptibility to infections, they don't directly cause septic shock in the absence of an underlying infection:

• According to the FDA label, "Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used" 2

• The risk increases with:

  • Higher doses
  • Longer duration of treatment
  • Pre-existing immunocompromised state
  • Presence of latent infections

Clinical Assessment Algorithm

To determine if prednisolone could lead to septic shock in this patient:

1. Evaluate for pre-existing infection:

   • Normal temperature ✓
   • Normal WBC count ✓
   • Normal peripheral smear ✓
   • Negative typhidot test ✓
   • No signs of organ dysfunction (based on available information)

2. Apply sepsis criteria:

   • According to the BMJ guideline, sepsis requires evidence of infection plus organ dysfunction (SOFA score ≥2) 3
   • This patient shows no evidence of infection or organ dysfunction

3. Consider risk factors for corticosteroid-induced complications:

   • No evidence of latent tuberculosis or fungal infection mentioned
   • No evidence of immunocompromised state
   • No evidence of specific pathogens that might be activated by corticosteroids 2

Important Caveats and Precautions

Despite the low risk of prednisolone causing septic shock in this scenario, several precautions should be noted:

• Monitor for masked infection: Corticosteroids can mask signs of infection, making early detection more difficult 2

• Watch for specific infections: Corticosteroids may activate latent infections such as tuberculosis, amebiasis, or strongyloidiasis 2

• Avoid in untreated infections: Guidelines suggest against corticosteroid administration in patients with sepsis without shock 3

• Be cautious with prolonged use: Long-term use increases risk of immunosuppression and infection

Conclusion

Based on the clinical presentation (normal temperature, normal CBC, normal peripheral smear, negative typhidot) and the moderate dose of prednisolone (40mg), there is no evidence to suggest that this medication would cause septic shock or death in this 73kg woman. The patient lacks the prerequisite infection and organ dysfunction required for sepsis development.

If the patient were to develop fever, hypotension, tachycardia, or other signs of infection while on prednisolone, prompt medical evaluation would be warranted, as corticosteroids can mask or exacerbate infections in some circumstances.