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 .