RESUMEN
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.
Asunto(s)
Budesonida/efectos adversos , Síndrome de Cushing/inducido químicamente , Inhibidores del Citocromo P-450 CYP3A/efectos adversos , Glucocorticoides/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Ritonavir/efectos adversos , Administración por Inhalación , Síndrome de Cushing/diagnóstico , Diagnóstico Diferencial , Interacciones Farmacológicas , Femenino , Infecciones por VIH/complicaciones , Síndrome de Lipodistrofia Asociada a VIH/diagnóstico , Humanos , Enfermedad Iatrogénica , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/complicacionesRESUMEN
We present a case of a 46-year-old man with a history significant only for hypertension and depression that presented with a new onset seizure resulting from a right parietal lobe mass. Further evaluation determined the parietal mass to be central nervous system toxoplasmosis, which was the initial presentation of his underlying HIV/AIDS. This case provided a diagnostic challenge and demonstrates the importance of a thorough evaluation as it pertains to a newly diagnosed brain lesion.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico , Infecciones por VIH/complicaciones , Convulsiones/etiología , Toxoplasmosis Cerebral/complicaciones , Diagnóstico Diferencial , Infecciones por VIH/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Lóbulo Parietal/patología , Toxoplasmosis Cerebral/diagnóstico , Toxoplasmosis Cerebral/etiología , Toxoplasmosis Cerebral/patologíaRESUMEN
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.
