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 "blood pressure" symptom

acute rheumatic fever

adrenal incidentaloma

alpha-thalassemia

cadasil

congenital adrenal hyperplasia

congenital diaphragmatic hernia

cushing syndrome

fabry disease

familial mediterranean fever

lymphangioleiomyomatosis

pendred syndrome

proteus syndrome

scrub typhus

systemic capillary leak syndrome

thoracic outlet syndrome

typhoid

von hippel-lindau disease

werner syndrome

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