ABSTRACT
Introduction: Italy, since the end of February 2020, is experiencing the corona virus disease 2019 (COVID-19) pandemic that may present as an acute respiratory infection. We report on COVID-19 pneumonia in the context of a complex case of Cushing's disease (CD). Case Report: A 67-year-old man with CD, who was admitted to our hospital, presented with signs and symptoms of adrenal insufficiency with persistent hypotension and glycemia toward the lower limits. We progressively withdrew almost all treatments for diabetes and CD (pasireotide and metyrapone), and i.v. hydrocortisone was necessary. A tendency to hyperkalemia was probably associated to enoxaparin. We summarized the many possible interactions between medications of Cushing's syndrome (CS) and COVID-19. Conclusion: Adrenal insufficiency might be a clinical challenge that needs a prompt treatment also in CS patients during COVID-19 infection. We should consider the possibility to titrate or temporary halt medical therapies of CS in the context of COVID-19 infection. Unexpected hyperkalemia in CS patients under treatment with heparin might be the signal of aldosterone suppression.
Subject(s)
Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Cushing Syndrome/drug therapy , Hydrocortisone/therapeutic use , Metyrapone/therapeutic use , Pneumonia, Viral/drug therapy , Aged , Anti-Inflammatory Agents/therapeutic use , Antimetabolites/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Cushing Syndrome/complications , Cushing Syndrome/virology , Disease Management , Humans , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2ABSTRACT
Corticosteroids, even in topical application, may cause immunosuppression and Cushing's syndrome. A case of disseminated fatal cytomegalovirus infection is reported in a 3-month-old girl with Cushing's syndrome caused by exogenous topical clobetasol propionate application, which might have caused immunosuppression due to prolonged use.
Subject(s)
Clobetasol/analogs & derivatives , Cushing Syndrome/chemically induced , Cushing Syndrome/virology , Cytomegalovirus Infections/complications , Cytomegalovirus/growth & development , Clobetasol/adverse effects , Cytomegalovirus Infections/virology , Fatal Outcome , Female , Humans , InfantABSTRACT
Reactivation of hepatitis B virus (HBV) replication in hepatitis B surface antigen (HBsAg)-positive patients is associated with immunosuppressive therapy. However, the interactions between endogenous glucocorticoid in Cushing's syndrome and HBV-related hepatitis remain unclear. Here, we describe the management of a 32-year-old male HBV carrier with Cushing's syndrome caused by an adrenal cortical adenoma, who developed severe hepatitis B. Repeated episodes of septicemia resulting from hypercortisolemia-related immunosuppression further compromised his hepatic condition. Adrenalectomy could not be performed due to coagulopathy. Lamivudine was not available at that time in Taiwan, and this patient died of hepatic failure and sepsis. At autopsy, his liver showed submassive necrosis with small regenerative nodules. The hepatocytes were positive for HBsAg (membrane and cytoplasmic) and hepatitis B core antigen (nuclear and cytoplasmic). Screening for HBsAg is of crucial significance for immunocompromised individuals. Once positive HBsAg is detected in immunosuppressed patients, liver function and viral status should be closely monitored to enable earlier diagnosis and prompt treatment with the newer nucleoside analogues that actively fight HBV.
