A 10 year old boy presented to our hospital with nephrotic syndrome relapse and signs of steroid toxicity in the form of posterior capsular cataract, affection of linear growth and stage 2 hypertension, in addition to steroid induced adiposity and fungal infection of the scalp resulting in cicatricial alopecia. He was diagnosed as nephrotic syndrome 6 months back. He went into remission with steroid therapy, but was inadvertently taking steroids in high doses for 5 months. When the dose of steroid was tapered, patient had relapse of nephrotic syndrome. As per IAP consensus guidelines for steroid sensitive nephrotic syndrome [1], relapse is to be treated with steroids first. As this patient is suffering from serious steroid toxicity already, is it appropriate to use second line drugs straightway?