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Iatrogenic cushing syndrome secondary to ritonavir-epidural triamcinolone interaction: an illustrative case and review.
[cushing syndrome]
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
.
Diseases
Validation
Diseases presenting
"positive patients on ritonavir-containing antiretroviral"
symptom
cushing syndrome
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