Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide
Iatrogenic Cushing syndrome (CS) is a well-known complication of treating patients with systemic steroids. More rarely, it has been described in HIV-positive patients on ritonavir (RTV) while using the inhaled corticosteroid fluticasone, which is metabolized through the cytochrome P450 3A4 (CYP3A4)...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2017-11-01
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| Series: | Journal of the International Association of Providers of AIDS Care |
| Online Access: | https://doi.org/10.1177/2325957417736612 |
| _version_ | 1819181935791964160 |
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| author | Lily Colpitts MD Thomas B. Murray MD Sami G. Tahhan MD, FACP Jody P. Boggs MD, FACP |
| author_facet | Lily Colpitts MD Thomas B. Murray MD Sami G. Tahhan MD, FACP Jody P. Boggs MD, FACP |
| author_sort | Lily Colpitts MD |
| collection | DOAJ |
| description | Iatrogenic Cushing syndrome (CS) is a well-known complication of treating patients with systemic steroids. More rarely, it has been described in HIV-positive patients on ritonavir (RTV) while using the inhaled corticosteroid fluticasone, which is metabolized through the cytochrome P450 3A4 (CYP3A4) enzyme system. In the presence of RTV, a known CYP3A4 enzyme inhibitor, the interaction can result in impaired metabolism and systemic accumulation of inhaled fluticasone resulting in iatrogenic CS. Iatrogenic CS has been less often described with inhaled budesonide compared to inhaled fluticasone. Therefore, inhaled budesonide is often used as an alternative therapy for patients on RTV to avoid iatrogenic CS. We report the fifth case report of budesonide-induced iatrogenic CS in an HIV-positive patient on RTV. We highlight the importance of early recognition of the syndrome and distinguishing it from HIV lipodystrophy. Finally, we review the literature for cases of iatrogenic CS involving RTV and commonly used steroids. |
| first_indexed | 2024-12-22T22:38:09Z |
| format | Article |
| id | doaj.art-1c3a2a5073f340a3bbb767a697164af4 |
| institution | Directory Open Access Journal |
| issn | 2325-9574 2325-9582 |
| language | English |
| last_indexed | 2024-12-22T22:38:09Z |
| publishDate | 2017-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of the International Association of Providers of AIDS Care |
| spelling | doaj.art-1c3a2a5073f340a3bbb767a697164af42022-12-21T18:10:15ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95742325-95822017-11-011610.1177/2325957417736612Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled BudesonideLily Colpitts MD0Thomas B. Murray MD1Sami G. Tahhan MD, FACP2Jody P. Boggs MD, FACP3 Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA Riverside Shore Memorial Hospital, Onancock, VA, USA Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USAIatrogenic Cushing syndrome (CS) is a well-known complication of treating patients with systemic steroids. More rarely, it has been described in HIV-positive patients on ritonavir (RTV) while using the inhaled corticosteroid fluticasone, which is metabolized through the cytochrome P450 3A4 (CYP3A4) enzyme system. In the presence of RTV, a known CYP3A4 enzyme inhibitor, the interaction can result in impaired metabolism and systemic accumulation of inhaled fluticasone resulting in iatrogenic CS. Iatrogenic CS has been less often described with inhaled budesonide compared to inhaled fluticasone. Therefore, inhaled budesonide is often used as an alternative therapy for patients on RTV to avoid iatrogenic CS. We report the fifth case report of budesonide-induced iatrogenic CS in an HIV-positive patient on RTV. We highlight the importance of early recognition of the syndrome and distinguishing it from HIV lipodystrophy. Finally, we review the literature for cases of iatrogenic CS involving RTV and commonly used steroids.https://doi.org/10.1177/2325957417736612 |
| spellingShingle | Lily Colpitts MD Thomas B. Murray MD Sami G. Tahhan MD, FACP Jody P. Boggs MD, FACP Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide Journal of the International Association of Providers of AIDS Care |
| title | Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide |
| title_full | Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide |
| title_fullStr | Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide |
| title_full_unstemmed | Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide |
| title_short | Iatrogenic Cushing Syndrome in a 47-Year-Old HIV-Positive Woman on Ritonavir and Inhaled Budesonide |
| title_sort | iatrogenic cushing syndrome in a 47 year old hiv positive woman on ritonavir and inhaled budesonide |
| url | https://doi.org/10.1177/2325957417736612 |
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