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Case Report
Iatrogenic Cushing syndrome secondary to enhanced protease inhibitors: Case report and review
1 Courtyards Surgery, 1 Poynders Road, SW4 8NU, London, UK
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Vernon De Maynard
Courtyards Surgery, 1 Poynders Road, SW4 8NU, London,
UK
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Article ID: 100004Z16VM2019
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De Maynard V. Iatrogenic Cushing syndrome secondary to enhanced protease inhibitors: Case report and review. J Case Rep Images Infect Dis 2019;2:100004Z16VM2019.ABSTRACT
Introduction: Human Immunodeficiency Virus (HIV+ve) positive patients taking enhanced Protease Inhibitors (ePI) can develop Iatrogenic Cushing Syndrome (ICS) and adrenal insufficiency that did not appear to be associated with intralesional, intra-articular, inhaled or intranasal, topical glucocorticoid therapy. Given the expected reduction in the patient’s capacity to remove cortisol from the body a high index of clinical suspicion is required for diagnosis. Case Report: This paper describes a 58-yearold man whose HIV ceased to be well-controlled on ePI-based Anti-Retroviral Therapy (ART) twice, and who developed Cushing syndromelike symptoms including keloid scars and faecal incontinence in association with a chronic cortisolaemia. Conclusion: Enhanced protease inhibitors have proven an important course of treatment in the fight against HIV/AIDS. However; these very powerful drugs can have unintended consequences that are not very well documented. As stress and its relation to cortisol are well documented, future should attempt to examine the relationship between perceived stress and HIV viral load and determine how serum cortisol might mediate the relationship between psychological stress and viral load in patients taking ePI ART.
Keywords: Acquired immune deficiency syndrome, Enhanced protease inhibitors, Human Immunodeficiency Virus , Iatrogenic cushing syndrome, Stress
SUPPORTING INFORMATION
Author Contributions
Vernon De Maynard - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Vernon De Maynard. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
