ABSTRACT
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.
Subject(s)
Budesonide/adverse effects , Cushing Syndrome/chemically induced , Cytochrome P-450 CYP3A Inhibitors/adverse effects , Glucocorticoids/adverse effects , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Pulmonary Disease, Chronic Obstructive/drug therapy , Ritonavir/adverse effects , Administration, Inhalation , Cushing Syndrome/diagnosis , Diagnosis, Differential , Drug Interactions , Female , HIV Infections/complications , HIV-Associated Lipodystrophy Syndrome/diagnosis , Humans , Iatrogenic Disease , Middle Aged , Pulmonary Disease, Chronic Obstructive/complicationsSubject(s)
Empyema, Pleural/diagnosis , Mycobacterium tuberculosis , Nontuberculous Mycobacteria , Tuberculosis/diagnosis , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Nontuberculous Mycobacteria/isolation & purification , Tuberculosis/complicationsABSTRACT
This article reviews various infectious disease emergencies from an internist's perspective. Key epidemiologic, diagnostic, and therapeutic points are reviewed with an emphasis on timely and appropriate initial management. The content serves to highlight essential points that are discussed in subsequent articles in this issue and to elucidate pearls that may facilitate timely and appropriate management.
Subject(s)
Disease Outbreaks/prevention & control , Emergency Service, Hospital/organization & administration , Infection Control/organization & administration , Internal Medicine/organization & administration , Humans , Incidence , Physical Examination , Public Health , United States/epidemiologyABSTRACT
A 48-year-old man presented with fevers, chills, weight loss, multiple liver masses, and several superficial and deep venous thromboses in lower extremities. Cancer work up was negative. A liver biopsy grew Fusobacterium nucleatum. To our knowledge, F. nucleatum infection presenting with multiple liver masses and Trousseau-like syndrome has not been reported earlier.
