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Iatrogenic Cushing syndrome is a well-known adverse reaction of steroids, but there are few reports of this condition caused by topical agents. Although systemic side effects from topical steroids are rare, lack of physician awareness and patient guidance can lead to a risk of adverse reaction of steroids. A 12-year-old girl had been treated with betamethasone butyrate propionate as atopic dermatitis from age 6. However, her family doctor continued to prescribe without explaining how to use and the risks of side effects. As a result of continuing to apply 15 grams of it all over her body every week, except in summer when skin symptoms were mild, she developed Cushing syndrome and was referred to our hospital after short stature was reviled at school physical examination. Although MRI scan indicated possible anterior pituitary suppression, there were no suppressive findings in the hormone loading test. With appropriate topical steroids, Cushing symptoms have generally improved, and the decline in the growth rate of her height has stopped. Thus, topical corticosteroids can cause systemic side effects in children. We should avoid inappropriate topical steroids use and properly instruct patients and their families about the use of the drugs and the side effects of treatment.

Microangiopathic haemolytic anaemia with thrombocytopenia, called pseudo-thrombotic microangiopathy (TMA), is a clinically important complication in patients with vitamin B12 deficiency. We herein present a case of an 80-year-old woman with pseudo-TMA after gastrectomy. She was initially suspected with thrombotic thrombocytopenic purpura based on rapid progression of anaemia with schistocytes and thrombocytopenia; however, her anaemia and thrombocytopenia were improved by vitamin B12 supplementation alone, with a single session of plasma exchange. Vitamin B12 deficiency was finally confirmed by low vitamin B12 levels from the patient’s initial blood sample. In addition, normal ADAMTS13 activity was proven, lowering the likelihood of thrombotic thrombocytopenic purpura. Therefore, this patient was diagnosed with pseudo-TMA caused by vitamin B12 deficiency. Pseudo-TMA can occur in patients with vitamin B12 deficiency post-gastrectomy.