Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review
HIV positive patients on ritonavir-containing antiretroviral therapy (ART) can develop iatrogenic Cushing syndrome (IACS) and adrenal insufficiency as a result of drug-drug interactions with inhaled or intranasal glucocorticoid therapy. Reports related to epidural triamcinolone injections are relati...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Interdisciplinary Perspectives on Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2014/849432 |
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| author | Sapna Sadarangani Melody L. Berg William Mauck Stacey Rizza |
| author_facet | Sapna Sadarangani Melody L. Berg William Mauck Stacey Rizza |
| author_sort | Sapna Sadarangani |
| collection | DOAJ |
| description | HIV positive patients on ritonavir-containing antiretroviral therapy (ART) can develop iatrogenic Cushing syndrome (IACS) and adrenal insufficiency as a result of drug-drug interactions with inhaled or intranasal glucocorticoid therapy. Reports related to epidural triamcinolone injections are relatively uncommon but increasingly reported. We describe a 48-year-old woman with immunologically and virologically well-controlled HIV on ritonavir-based ART, who developed headache, dizziness, and candida and herpes simplex virus (HSV) ulcerative esophagitis 7 days after receiving an epidural triamcinolone injection for cervical radicular pain. Iatrogenic Cushing syndrome and relative adrenal insufficiency were suspected and proven. The patient’s ART was changed to a non-HIV protease inhibitor- (PI-) containing program, her symptoms improved, and she did not require hydrocortisone replacement. In this paper, we review the literature on IACS and relative secondary adrenal insufficiency from epidural triamcinolone injections in HIV patients on ritonavir-containing ART regimens. A high index of clinical suspicion is needed for diagnosis. Prevention of drug-drug interactions by taking a thorough medication history for patients on ritonavir-containing ART regimens before prescribing any form of corticosteroid is crucial and effective and sustained interdisciplinary communication in the care of such patients. |
| format | Article |
| id | doaj-art-d1a4624d59b648f6a72293445a2a40fe |
| institution | Kabale University |
| issn | 1687-708X 1687-7098 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Interdisciplinary Perspectives on Infectious Diseases |
| spelling | doaj-art-d1a4624d59b648f6a72293445a2a40fe2025-02-03T01:26:08ZengWileyInterdisciplinary Perspectives on Infectious Diseases1687-708X1687-70982014-01-01201410.1155/2014/849432849432Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and ReviewSapna Sadarangani0Melody L. Berg1William Mauck2Stacey Rizza3Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAAmbulatory Care Pharmacy Services, Indiana University Health LifeCare Clinic, Indianapolis, IN 46202, USADivision of Pain Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USADivision of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAHIV positive patients on ritonavir-containing antiretroviral therapy (ART) can develop iatrogenic Cushing syndrome (IACS) and adrenal insufficiency as a result of drug-drug interactions with inhaled or intranasal glucocorticoid therapy. Reports related to epidural triamcinolone injections are relatively uncommon but increasingly reported. We describe a 48-year-old woman with immunologically and virologically well-controlled HIV on ritonavir-based ART, who developed headache, dizziness, and candida and herpes simplex virus (HSV) ulcerative esophagitis 7 days after receiving an epidural triamcinolone injection for cervical radicular pain. Iatrogenic Cushing syndrome and relative adrenal insufficiency were suspected and proven. The patient’s ART was changed to a non-HIV protease inhibitor- (PI-) containing program, her symptoms improved, and she did not require hydrocortisone replacement. In this paper, we review the literature on IACS and relative secondary adrenal insufficiency from epidural triamcinolone injections in HIV patients on ritonavir-containing ART regimens. A high index of clinical suspicion is needed for diagnosis. Prevention of drug-drug interactions by taking a thorough medication history for patients on ritonavir-containing ART regimens before prescribing any form of corticosteroid is crucial and effective and sustained interdisciplinary communication in the care of such patients.http://dx.doi.org/10.1155/2014/849432 |
| spellingShingle | Sapna Sadarangani Melody L. Berg William Mauck Stacey Rizza Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review Interdisciplinary Perspectives on Infectious Diseases |
| title | Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review |
| title_full | Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review |
| title_fullStr | Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review |
| title_full_unstemmed | Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review |
| title_short | Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review |
| title_sort | iatrogenic cushing syndrome secondary to ritonavir epidural triamcinolone interaction an illustrative case and review |
| url | http://dx.doi.org/10.1155/2014/849432 |
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