CONGRESS ABSTRACT

  Background Steroid-induced hypertrophic cardiomyopathy is a rare complication in children undergoing prolonged corticosteroid therapy. Although typically reported in preterm neonates, this case in a six-month-old infant without pre-existing cardiac conditions broadens current understanding of this condition, highlighting the importance of thorough diagnostic and therapeutic approaches.    Case Description A six-month-old infant was treated for bronchopneumonia with methylprednisolone (1 mg/kg/day for 5 days, followed by 1.5 mg/kg/day for 7 days) and oral betamethasone (0.1 mg/kg/day for 10 days). During first days of hospitalization, an initial cardiac evaluation, that included electrocardiogram and echocardiography, showed normal results. After 20 days from hospital admission, identification of a de novo systolic murmur mandated a new electrocardiogram that show left ventricole hypertrophy and a new echocardiogram, which revealed severe concentric and asymmetric left ventricular hypertrophy (relative wall thickness of the left ventricle >1), with an interventricular septal thickness of 12.5 mm (z-score 12) and a left ventricle outflow gradient >100 mmHg.   Discontinuation of corticosteroids and initiation of propranolol (0.6 mg/kg/day) led to a rapid reduction in the left outflow gradient to 36 mmHg within 48 hours and a complete normalization of hypertrophy in two weeks (septal thickness 6 mm, absence of left ventricle outflow gradient). The diagnosis of steroid-induced HCM was confirmed by excluding genetic, metabolic, and syndromic causes.    Conclusions Steroid-induced HCM is a reversible condition that should be suspected even in infants without pre-existing cardiac conditions, especially when the clinical history (rapid development, steroids administration, absent family history of cardiomyopathy) is suggestive. Timely diagnosis, based on the exclusion of alternative causes, prompt corticosteroid withdrawal and beta-blocker treatment are crucial in the management. Given the risks of adverse effects patient on corticosteroid therapy should be monitored for possible side effects.