Focal myopathy following local glucocorticoid injection

Abstract

Introduction: Few cases of local subcutaneous atrophy after corticosteroid injection have been described previously. Here, we report 2 patients who had weakness of hip extension and atrophy of the gluteus maximus after several intramuscular triamcinolone acetonide injections in the buttocks. Patient concerns: A 50-year-old woman presented with hand eczema and received biweekly intramuscular triamcinolone acetonide injections in the gluteus maximus. After 12 weeks, she experienced difficulty getting up from the armchair and walking upstairs, and noted asymptomatic, oval, gently sloped depressions of the bilateral hips around the injection sites. The other patient was a 45-year-old woman with a medical history of allergic rhinitis. One and a half years before admission, she received weekly intramuscular triamcinolone acetonide injections in the gluteus maximus for 4 weeks for seasonal allergic rhinitis allergic attacks. Six months before admission, she noted depressions in the bilateral hips around the injection sites. Diagnosis: Physical examination of both patients showed normal muscle strength, except for bilateral hip extension. Magnetic resonance imaging of the thigh revealed atrophy and fatty infiltration of the bilateral gluteus maximus. Interventions: The 2 patients started rehabilitation therapy. Outcomes: Six months later, their weakness and atrophy remained unchanged. Conclusions: The patients in this case report had weakness and atrophy secondary to the use of triamcinolone acetonide. Glucocorticoid-induced myopathy chiefly affects limb-girdle muscles, the focal form of which needs to be recognized.