# Eosinophilic Rhinosinusitis With Nonsteroidal Anti-inflammatory Drug (NSAID)-Exacerbated Respiratory Disease: A Case Report of Sodium Phosphate Corticosteroids-Induced Complications

## TL;DR

A patient with respiratory conditions had a severe reaction to a corticosteroid, highlighting risks in medication selection for similar cases.

## Contribution

This case report highlights a rare complication of sodium phosphate corticosteroids in patients with N-ERD and ECRS.

## Key findings

- A rapid intravenous injection of hydrocortisone sodium phosphate caused ventilation failure in a patient with ECRS and asthma.
- Skin prick testing confirmed a positive reaction to hydrocortisone sodium phosphate.
- Additives in corticosteroids may trigger N-ERD attacks, even in patients without prior NSAID-induced reactions.

## Abstract

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a hypersensitivity disorder characterized by asthma, nasal polyposis, and NSAID intolerance. Eosinophilic chronic rhinosinusitis (ECRS) coexists with N-ERD in approximately 7.4% of cases. As sodium succinate corticosteroids (SSC) may exacerbate respiratory symptoms in patients with N-ERD, sodium phosphate corticosteroids (SPC) are generally recommended as an alternative. This report presents a case in which SPC additives possibly triggered an N-ERD attack during surgery in a patient with ECRS and bronchial asthma. A 58-year-old woman with a history of bronchial asthma was suspected of having ECRS and underwent surgery for diagnostic and therapeutic purposes. During the procedure, a rapid intravenous injection of hydrocortisone sodium phosphate (HSP) led to complete ventilation failure. Postoperative skin prick testing confirmed a positive reaction to HSP. Although anaphylactic shock was initially suspected, the possibility that additives in HSP induced N-ERD attack was also considered. N-ERD is primarily induced by COX-1 inhibitors, but additives such as parabens may also trigger the condition. Furthermore, rapid intravenous administration of corticosteroids has been reported to exacerbate asthma, potentially contributing to this patient’s reaction. Since N-ERD is typically acquired later in life, it should be considered even in patients with no prior history of NSAID-induced attacks, particularly when factors such as severe asthma and olfactory dysfunction are present. This case highlights the importance of selecting suitable medications in patients with N-ERD to prevent life-threatening attacks.