{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:42:12Z","timestamp":1792384932450,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100021016","name":"Istituto di Ricovero e Cura a Carattere Scientifico","doi-asserted-by":"publisher","award":["34\/18"],"award-info":[{"award-number":["34\/18"]}],"id":[{"id":"10.13039\/100021016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glucocorticoids (GCs) are essential in paediatric inflammatory and immune\u2010mediated diseases but are associated with dose\u2010 and duration\u2010dependent toxicity. Pharmacogenetic variability in metabolic and transporter pathways may contribute to inter\u2010individual differences in GC adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 7\u2010year\u2010old girl with recurrent IgA vasculitis required prolonged corticosteroid therapy. During treatment, she developed marked Cushingoid features, progressive proximal muscle weakness, and severe fatigability consistent with steroid\u2010induced myopathy. Pharmacogenetic analysis revealed a\n                      <jats:italic>CYP3A4<\/jats:italic>\n                      intermediate metabolizer genotype and\n                      <jats:italic>CYP3A5<\/jats:italic>\n                      poor metabolizer genotype, without relevant variants in\n                      <jats:italic>ABCB1<\/jats:italic>\n                      or\n                      <jats:italic>ABCG2<\/jats:italic>\n                      .\n                      <jats:italic>NLRP3<\/jats:italic>\n                      methylation analysis was normal. Gradual steroid tapering combined with intravenous immunoglobulin therapy resulted in rapid clinical improvement and sustained remission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      A systematic review of PubMed, Embase, and Scopus up to March 2026 identified seven eligible studies. Evidence on associations between\n                      <jats:italic>CYP3A4<\/jats:italic>\n                      ,\n                      <jats:italic>CYP3A5<\/jats:italic>\n                      ,\n                      <jats:italic>ABCB1<\/jats:italic>\n                      , and\n                      <jats:italic>ABCG2<\/jats:italic>\n                      polymorphisms and GC\u2010related adverse effects in children was limited and inconsistent, without strong genotype\u2013phenotype correlations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests that combined CYP variants may contribute to increased glucocorticoid exposure and side effects. Although current evidence remains insufficient for routine clinical use, pharmacogenetic testing may be considered in selected cases with unexpected GC adverse effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70628","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:35:02Z","timestamp":1792384502000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Severe Steroid\u2010Induced Myopathy in a Child With a Pharmacogenetic Predisposition: A Case Report and Systematic Review of the Literature"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7817-7617","authenticated-orcid":false,"given":"Giada","family":"Caiffa","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences University of Trieste  Trieste 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