PMID- 24895495
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140624
LR  - 20211021
IS  - 1687-708X (Print)
IS  - 1687-7098 (Electronic)
IS  - 1687-708X (Linking)
VI  - 2014
DP  - 2014
TI  - Iatrogenic cushing syndrome secondary to ritonavir-epidural triamcinolone 
      interaction: an illustrative case and review.
PG  - 849432
LID - 10.1155/2014/849432 [doi]
LID - 849432
AB  - 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.
FAU - Sadarangani, Sapna
AU  - Sadarangani S
AUID- ORCID: 0000-0002-8781-0713
AD  - Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 
      55905, USA.
FAU - Berg, Melody L
AU  - Berg ML
AD  - Ambulatory Care Pharmacy Services, Indiana University Health LifeCare Clinic, 
      Indianapolis, IN 46202, USA.
FAU - Mauck, William
AU  - Mauck W
AUID- ORCID: 0000-0003-0704-181X
AD  - Division of Pain Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, 
      USA.
FAU - Rizza, Stacey
AU  - Rizza S
AUID- ORCID: 0000-0002-2854-2915
AD  - Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 
      55905, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20140507
PL  - Egypt
TA  - Interdiscip Perspect Infect Dis
JT  - Interdisciplinary perspectives on infectious diseases
JID - 101496545
PMC - PMC4033556
EDAT- 2014/06/05 06:00
MHDA- 2014/06/05 06:01
PMCR- 2014/05/07
CRDT- 2014/06/05 06:00
PHST- 2013/12/31 00:00 [received]
PHST- 2014/04/17 00:00 [revised]
PHST- 2014/04/18 00:00 [accepted]
PHST- 2014/06/05 06:00 [entrez]
PHST- 2014/06/05 06:00 [pubmed]
PHST- 2014/06/05 06:01 [medline]
PHST- 2014/05/07 00:00 [pmc-release]
AID - 10.1155/2014/849432 [doi]
PST - ppublish
SO  - Interdiscip Perspect Infect Dis. 2014;2014:849432. doi: 10.1155/2014/849432. Epub 
      2014 May 7.