Steroid-induced psychosis is a known adverse effect of treatment with corticosteroids. On average, the time of onset is several days after exposure to the steroid. A 91-year-old man presented with left buttock pain with radicular features and was found to have severe left lateral recess spinal canal stenosis on MRI. He was started on a prednisone taper and developed steroid-induced psychosis one day later. He was treated with a short course of antipsychotic medication. This case discusses the unusually rapid onset of steroid-induced psychosis at a dose of prednisone that does not commonly cause this adverse effect. It emphasizes important considerations when starting steroids in patients with advanced age and comorbidities that may impact the metabolism of steroids.

Ibuprofen, an inhibitor of prostanoid biosynthesis, is a common pharmacological agent used for the management of pain, inflammation and fever. However, the chronic use of ibuprofen at high doses is associated with increased risk for cardiovascular, renal, gastrointestinal and liver injuries. The underlying mechanisms of ibuprofen-mediated effects on liver remain unclear. To determine the mechanisms and signaling pathways affected by ibuprofen (100 mg/kg/day for seven days), we performed proteomic profiling of male mice liver with quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) using ten-plex tandem mass tag (TMT) labeling. More than 300 proteins were significantly altered between the control and ibuprofen-treated groups. The data suggests that several major pathways including (1) energy metabolism, (2) protein degradation, (3) fatty acid metabolism and (4) antioxidant system are altered in livers from ibuprofen treated mice. Independent validation of protein changes in energy metabolism and the antioxidant system was carried out by Western blotting and showed sex-related differences. Proteasome and immunoproteasome activity/expression assays showed ibuprofen induced gender-specific proteasome and immunoproteasome dysfunction in liver. The study observed multifactorial gender-specific ibuprofen-mediated effects on mice liver and suggests that males and females are affected differently by ibuprofen.