Hypokalemic myopathy associated with intranasal steroid use (factitious mineralocorticoid excess syndrome)

A patient is described, who had muscle necrosis occurring with hypokalemia and a factitious mineralocorticoid excess syndrome. The syndrome was due to the prolonged use of a nasal spray containing 9-alpha-fluoroprednisolone acetate, a steroid with potent mineralocorticoid activity. It is emphasized that intranasal administration of steroid compounds must be considered in the differential diagnosis of hypokalemia and related muscle disorders.