A 40-year-old woman on long-term prednisolone 15 mg daily for systemic lupus erythematosus abruptly stops her medication after 8 months of therapy. She presents 2 days later with severe myalgia, arthralgia, fatigue, and hypotension. This constellation is best described as:

• A Addisonian crisis due to HPA axis suppression
• B Relapse of underlying SLE
• C Steroid withdrawal syndrome ✓
• D Secondary infection due to immunosuppression

Explanation

Steroid withdrawal syndrome is a distinct entity from adrenal insufficiency. It presents with pseudorheumatism (severe myalgia, arthralgia, fatigue), malaise, and sometimes hypotension, despite adequate cortisol levels. It occurs due to glucocorticoid receptor downregulation and physical dependence. Addisonian crisis (option A) features hyponatremia, hyperkalemia, and hyperpigmentation, which are absent here. This distinction is clinically important for management.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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