CASEREPORT  
STEROID-INDUCED MYOPATHY IN A 10 -YEAR-OLD BOY WITH NEPHROTIC SYNDROME:  
A CASE REPORT  
Syed Sajid Hussain Shah1  
How to cite this article  
ABSTRACT  
OBJECTIVES  
Shah SSH. Steroid-Induced Myopathy  
in a 10-year-old Boy with Nephrotic  
Syndrome: A Case Report. J Gandhara  
Med Dent Sci. 2026;13(2):127-129  
https://doi.org/10.37762/jgmds.13-2.887  
A 10-year-old boy who was undergoing protracted corticosteroid therapy for  
nephrotic syndrome presented with progressive lower back pain and diculty  
walking, ultimately resulting in bed rest for a week. The clinical picture  
raised suspicion for steroid-induced myopathy, as there were normal ndings  
on MRI spine, EMG, and nerve conduction investigations, as well as normal  
CPK level. Detailed evaluation and neurology consultation were conducted  
to exclude any additional neuromuscular causes. The patient's functional  
recovery was gradual as a result of steroid tapering, physiotherapy, and  
parents' education. He regained full mobility and resumed his regular daily  
activities at the two-week follow-up. This case highlights the signicance of  
identifying steroid-induced myopathy in children who are taking long-term  
steroids. Early identication and supportive care can prevent long-term  
disability and result in a full recovery.  
Date of Submission: 10-03-2026  
Date Revised:  
Date Acceptance:  
21-03-2026  
27-03-2026  
Correspondence  
1Syed Sajid Hussain Shah, Assistant  
Professor, Department of Nephrology,  
Institute of Kidney Diseases, Khyber  
Girls Medical College, Peshawar  
KEYWORDS: Nephrotic Syndrome, Steroids, Myopathy  
:
:
+92-334-8951184  
syed_sajid20@yahoo.com  
CASE REPORT  
INTRODUCTION  
In nephrotic syndrome, protein is leaked from the  
circulation into the urine through the glomeruli, leading  
to hypoproteinemia and generalized edema.1 One of the  
systematic reviews in children less than 16 years  
showed the annual incidence rate of 2 to 7 new cases  
per 100,000 children/year, and a prevalence rate of  
0.016%.2 Nephrotic syndrome is also prevalent in  
children in Pakistan, but the exact incidence and  
prevalence are not known. Steroids are the main  
treatment drug in the management of nephrotic  
syndrome. Multiple adverse clinical eects, including  
hypertension, insulin resistance, impaired wound  
healing, immunosuppression, and osteoporosis, are  
associated with the chronic ingestion of high-dose  
corticosteroids. Myopathy is one of the adverse eects  
of steroids.3 Myopathy (muscle weakness) encompasses  
an extensive dierential diagnosis. The nonspecic  
symptoms of muscle involvement are frequently  
masked by the patient’s underlying disease, leading to  
under-recognition.4 We are presenting a case report of  
one patient who developed glucocorticoid-induced  
myopathy with prolonged use of steroids for a  
continuous 18 months after taking proper consent. As in  
literature, we could not get any case report published in  
Pakistan on children with glucocorticoid-induced  
myopathy.  
We report a case of a 10-year-old boy who was  
diagnosed and treated for nephrotic syndrome. The  
patient has been taking steroids continuously for the  
past 18 months, with intermittent reductions in the  
dosage, but was never o. The patient had been  
experiencing diculty walking for the past month prior  
to presenting to the hospital. Subsequently, he got  
bedridden for one week. (Figure 1) As the patient  
developed symptoms, parents stopped the steroids. The  
patient was referred to a tertiary care hospital by the  
local hospital. The workup, which included an MRI of  
the spine, was unremarkable. The patient was  
subsequently referred to our institute for management.  
The patient’s medical history was meticulously  
recorded.  
Nerve  
conduction  
investigations  
and  
electromyography were unremarkable, while the CPK  
level was 30.4 IU. Neurology input was taken  
management of patients was done instead of steroid-  
induced myopathy. Parents were educated, and physical  
therapy was administered. The patient’s condition  
started to improve. The patient was discharged home  
after he began walking with assistance. A follow-up  
was conducted 2 weeks later, and the patient was able  
to walk and perform daily activities normally (Figure  
2).  
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J Gandhara Med Dent Sci  
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Steroid-Induced Myopathy in a 10 Year Old Boy  
daily living.6,7 Our patient was on steroids for eighteen  
months without a complete steroid-free interval in this  
instance. His symptoms of progressive paralysis and  
back pain initially raised  
concerns regarding  
however, structural or  
neurological pathology;  
neuropathic causes were ruled out by a normal MRI  
spine, normal nerve conduction studies, and EMG  
findings. The management of the condition entailed  
discontinuing  
or  
reducing  
corticosteroids  
and  
implementing supportive physiotherapy. The patient's  
extraordinary recovery over a brief period underscores  
the reversibility of this condition when detected early.  
This case highlights the signicance of evaluating  
iatrogenic causes, such as steroid myopathy, in children  
who have chronic illnesses and have used steroids for  
an extended period of time, particularly when they  
present with musculoskeletal complaints. One case  
report by Pokharel S et al. showed that steroids also  
induce psychosis in children with nephrotic syndrome.8  
Figure 1: Bedridden Patient at Presentation  
CONCLUSIONS  
Although uncommon, steroid-induced myopathy should  
be taken into account by any paediatric patient who  
exhibits progressive muscle weakness with no  
neurological ndings and has received prolonged  
corticosteroid exposure.  
CONFLICT OF INTEREST: None  
FUNDING SOURCES: None  
REFERENCES  
1. Hahn D, Samuel SM, Willis NS, Craig JC, Hodson EM.  
Corticosteroid therapy for nephrotic syndrome in children.  
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10.1002/14651858.CD001533.pub7.  
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AK, Alenezi YH, et al. Overview of Nephrotic Syndrome in  
Arab Children: Systematic review. SMHJ 2023;4(1):41-7.  
3. Vivarelli M, Gibson K, Sinha A, Boyer O. Childhood nephrotic  
Figure 2: Patient on Follow-Up  
DISCUSSION  
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Lancet  
2023;402(10404):809-24.  
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10.1016/S0140-6736(23)01051-6.  
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patient SLE. Am J Case Rep 2018;19:277-83.  
5. Hu Y, Lu C, Lin H. Concurrence of osteonecrosis and steroid  
myopathy secondary to oral steroid therapy in a patient with  
ABCB1 gene polymorphisms: A case report. Front Endocrinol  
2022;7:13.  
6. Wu M, Yu J, Zhong A, Tang Y, Li M, Liu C, et al. Muscle  
ultrasound to identify prednisone-induced muscle damage in  
adults with nephrotic syndrome. Steroids 2024; 207:109434.  
7. Miernik S, Matusiewicz A, Olesińska M. Drug-induced  
myopathies: A comprehensive review and update. Biomedicines  
2024:12(5):987.  
Steroid/glucocorticoid-induced myopathy is the most  
prevalent form of drug-induced myopathy. It is  
characterized by atrophy, asymptomatic muscle  
weakness, and fatigue.5 The proximal symmetric  
muscles of the lower extremities are the primary target,  
while the postural muscles may also be signicantly  
affected. Signicant atrophy of the surrounding  
muscles may also be observed, as patients may  
progressively lose the ability to stand up from a low  
chair, climb stairs, and ultimately perform activities of  
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J Gandhara Med Dent Sci  
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Steroid-Induced Myopathy in a 10 Year Old Boy  
8. Pokharel S, Bhusal A, Bhattarai HB, Yogi TN, Bhandari P,  
AUTHORS CONTRIBUTION  
Syed Sajid Hussain Shah Concept  
Pandit D. Steroid-Induced Psychosis in a Child With Nephrotic  
Syndrome Secondary to Focal Segmental Glomerulosclerosis: A  
Case Report. Clin Case Rep. 2024 Nov 29;12(12):e9642. doi:  
10.1002/ccr3.9642. PMID: 39619317; PMCID: PMC11605252.  
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&
Design; Data  
Acquisition;  
Data  
Analysis/Interpretation; Drafting  
Manuscript; Critical Revision; Supervision; Final Approval  
The authors accept responsibility for all aspects of the work  
and will ensure that any concerns regarding the accuracy or  
integrity of any part are properly investigated and resolved.  
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