Iatrogenic cushing syndrome secondary to a probable interaction between voriconazole and budesonide.

[cushing syndrome]

Oral budesonide is commonly used for the management of Crohn 's disease given its high affinity for glucocorticoid receptors and low systemic activity due to extensive first -pass metabolism through hepatic cytochrome P 450 (CYP ) 3 A 4 . Voriconazole , a second -generation triazole antifungal agent , is both a substrate and potent inhibitor of CYP isoenzymes , specifically CYP 2 C 19 , CYP 2 C 9 , and CYP 3 A 4 ; thus , the potential for drug-drug interactions with voriconazole is high . To our knowledge , drug-drug interactions between voriconazole and corticosteroids have not been specifically reported in the literature . We describe a 48 -year -old woman who was receiving oral budesonide 9 Â mg /day for the management of Crohn 's disease and was diagnosed with fluconazole-resistant Candida albicans esophagitis ; oral voriconazole 200 Â mg every 12 Â hours for 3 Â weeks was prescribed for treatment . Because the patient experienced recurrent symptoms of dysphagia , a second 3 -week course of voriconazole therapy was taken . Seven weeks after originally being prescribed voriconazole , she came to her primary care clinic with elevated blood pressure , lower extremity edema , and weight gain ; she was prescribed a diuretic and evaluated for renal dysfunction . At a follow-up visit 6 Â weeks later with her specialty clinic , the patient 's blood pressure was elevated , and her physical examination was notable for moon facies , posterior cervical fat pad prominence , and lower extremity pitting edema . Iatrogenic Cushing syndrome due to a drug-drug interaction between voriconazole and budesonide was suspected , and voriconazole was discontinued . Budesonide was continued as previously prescribed for her Crohn 's disease . On reevaluation 2 Â months later , the patient 's Cushingoid features had markedly regressed . To our knowledge , this is the first published case report of iatrogenic Cushing syndrome due to a probable interaction between voriconazole and oral budesonide . In patients presenting with Cushingoid features who have received these drugs concomitantly , clinicians should consider the potential drug interaction between these agents , and the risks and benefits of continued therapy must be considered .

Diseases
Validation

Diseases presenting "cushing syndrome" symptom

adrenal incidentaloma

carcinoma of the gallbladder

congenital adrenal hyperplasia

cushing syndrome

This symptom has already been validated