Can “Steroid Switching” Improve Steroid-Induced Musical Hallucinations in a Patient with Terminal Cancer?

Abstract

The patient was a 57-year-old woman with malignant pleural mesothelioma. She had a past history of anxiety neurosis but not had any history of otological diseases. On admission to our hospice (day 1), she complained of dyspnea and wheezing associated with the progression of her underlying disease. After we started oral betamethasone (2 mg/d), dyspnea was alleviated and the frequency of wheezing was reduced. On day 3, she began to experience musical hallucinations that were manifested in opera/piano concert music and a child's voice. The episodes of musical hallucinations occurred approximately 10 times a day and disappeared spontaneously within several minutes. She had not experienced these symptoms before. We reduced the dose of betamethasone to 1 mg/d, but the musical hallucinations continued. Then on day 11, we switched betamethasone (1 mg/d) to prednisolone (10 mg/d) and we then gradually tapered off prednisolone. The frequency of musical hallucinations decreased and she ceased to experience musical hallucinations on day 29. However, on day 40, her dyspnea was aggravated again, so we started treatment with prednisolone (5 mg/d). Dyspnea was alleviated and no musical hallucinations occurred. On Day 51, dyspnea was worsened and we switched prednisolone to betamethasone (4 mg/d), which she hoped to use. The betamethasone alleviated the dyspnea but she developed musical hallucinations that were similar to the previous episodes. The musical hallucinations disappeared spontaneously 4-5 days later without changing the betamethasone. Musical hallucinations never occurred thereafter. She later died due to the exacerbation of disease.

Musical hallucinations: review of treatment effects

“…They include benzodiazepines [lormetazepam (Ginsberg, 2003), temazepam (Fisman, 1991), lorazepam (Curtin and Remund, 2002), and triazolam (Nevins, 1991)], opioids [morphine (Davies and Quinn, 2005), tramadol (Keeley et al, 2000) and oxycodone (Moore, 2003)], tricyclic antidepressants [imipramine (Terao, 1995), clomipramine (Vallada and Gentil, 1991) and mirtazapine (Padala et al, 2010)], anticholinergic medication [biperiden (Gertz et al, 1996)], alcohol (Scott, 1975), an N-methyl-D-aspartate antagonist [amantadine (Gondim et al, 2010)], a dopamine agonist [bromocriptine (Kobayashi et al, 2004)], salicylates (Allen, 2008), dipyridamole(Tomar and Cheung, 2007), propranolol (Fernandez and Crowther, 1998), voriconazole (Agrawal and Sherman, 2004), pentoxifylline (Gilbert, 1993) and steroids (Kanemura et al, 2010). …”

Oxymorphone Insufflation Associated with Acute Sensorineural Hearing Loss: Case Files of the University of Massachusetts Medical Toxicology Fellowship

“…Multiple case reports describe the development of musical hallucinations after medication (e.g., salicylates, propranolol, voriconazole, steroids, tricyclic antidepressants, amantidine, and dipyridamole) administration [23][24][25][26][27][28][29][30]. Whiplash injury and abdominal pain have also been associated with these hallucinations [31,32].…”

Drug-induced musical hallucination

“…Twenty-four articles met our inclusion criteria ( Vallada and Gentil, 1991 ; Terao, 1995 ; Kumagai et al, 2003 ; Padala et al, 2010 ; Muraosa et al, 2020 ; Kobayashi et al, 2004 ; Gondim Fde et al, 2010 ; Kataoka and Ueno, 2014 ; Keeley et al, 2000 ; Moore, 2003 ; Davies and Quinn, 2005 ; Powers et al, 2015 ; Agrawal and Sherman, 2004 ; Zonios et al, 2008 ; Fisman, 1991 ; Curtin and Redmund, 2002 ; al-Zahawi et al, 1988 ; Song and Jung, 2019 ; Gilbert, 1993 ; Tomar and Cheung, 2007 ; Blackman et al, 2019 ; Elikowski et al, 2021 ; Kanemura et al, 2010 ; Allen, 2008 ). The flow of the literature search is illustrated in Figure 1 .…”

“…Frontiers in Pharmacology frontiersin.org Zahawi et al, 1988;Song and Jung, 2019;Gilbert, 1993;Tomar and Cheung, 2007;Blackman et al, 2019;Elikowski et al, 2021;Kanemura et al, 2010;Allen, 2008). The flow of the literature search is illustrated in Figure 1.…”