A patient is to receive systemic METHYLPREDNISOLONE. Which of the following is an ABSOLUTE contraindication?

Correct answer: C. Systemic (untreated) fungal infection

• A. Diabetes is a RELATIVE contraindication. Steroids raise blood glucose through gluconeogenesis and insulin resistance, so glycaemic control must be watched and hypoglycaemic therapy may need adjustment. Again, caution rather than prohibition.
• B. Hypertension is a RELATIVE contraindication/caution. Corticosteroids cause sodium and water retention and can raise blood pressure, so the patient needs closer monitoring — but this does not forbid the drug.
• C. CORRECT. The only true ABSOLUTE contraindications on the methylprednisolone label are SYSTEMIC FUNGAL INFECTION and known hypersensitivity to the drug. Corticosteroids suppress cell-mediated immunity, and giving them during a disseminated fungal infection permits uncontrolled fungal proliferation, which can be fatal.
• D. Osteoarthritis is an INDICATION for corticosteroid therapy, not a contraindication.

Note: Both are cautions. The item has been rebuilt with the true absolute contraindication included. If the exam forces a choice between HTN and DM, most keys favour the cardiovascular risk, but recognise that the question as recalled is flawed.