Steroid-induced psychosis in a heart transplant recipient: A case report

Psicosis inducida por esteroides en un paciente con trasplante cardíaco: Reporte de caso

Abstract

Introduction: Glucocorticoids are pillars of immunosuppression in heart transplantation, but they can cause serious neuropsychiatric effects, which are rarely described in this context. Clinical case: An adult with advanced heart disease undergoing orthotopic heart transplantation received boluses of methylprednisolone and tacrolimus as part of immunosuppressive induction. A few days later, the patient presented with mutism, intense distress, refusal to eat, and imperative auditory hallucinations, without impairment of consciousness or metabolic or structural alterations in complementary studies. Elevated tacrolimus levels were evident, so the immunosuppressive regimen was adjusted and temporarily replaced with cyclosporine. Discussion: The temporal relationship with steroid pulses, the clinical profile, and the exclusion of other etiologies support the diagnosis of glucocorticoid-induced psychotic disorder. The intervention combined optimization of immunosuppression with intravenous haloperidol and subsequent oral olanzapine, without discontinuing the corticosteroids necessary to prevent acute rejection. No psychotic recurrences were observed despite new pulses of methylprednisolone for cellular rejection. Conclusions: Corticosteroid-induced psychosis should be considered in the differential diagnosis of acute psychotic symptoms following heart transplantation. An interdisciplinary approach allows for control of psychiatric symptoms while preserving immunosuppression, and highlights the importance of specific monitoring and management protocols in high-complexity units. Keywords: Glucocorticoids; Heart Transplantation; Psychotic Disorders; Immunosuppressive Agents; Psychiatry (Source: MeSH, NLM).