When Steroids Backfire: A Case of Hyperosmolar Hyperglycemic State, Pneumocystis Pneumonia, and Cauda Equina Syndrome

Corticosteroids are potent anti-inflammatory and immunosuppressive agents frequently used in short courses for various conditions. However, prolonged or inappropriate use can lead to severe complications, including immunosuppression, metabolic derangements, and delayed diagnosis of underlying disease. Cauda equina syndrome is a neurosurgical emergency that can be masked by corticosteroid therapy, while chronic use also predisposes to opportunistic infections such as Pneumocystis jirovecii pneumonia. We present a case of corticosteroid-induced hyperosmolar hyperglycemic state, Pneumocystis jirovecii pneumonia, and cauda equina syndrome, illustrating the systemic consequences of unsupervised steroid use.