Abstract
Cushing's syndrome after topical ocular corticosteroid use is extremely rare. We describe a case of symptomatic Cushing's syndrome in an adolescent male with sight-threatening vernal keratoconjunctivitis on antiretroviral therapy for HIV-1 infection that included ritonavir, a potent cytochrome p450 CYP3A4 inhibitor. CYP3A4 inhibition reduces the metabolism of exogenous corticosteroids leading to suppression of endogenous steroid production and Cushing's syndrome.
MeSH terms
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Adolescent
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Adrenal Cortex Hormones / administration & dosage
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Adrenal Cortex Hormones / adverse effects*
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Anti-Inflammatory Agents / administration & dosage
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Anti-Inflammatory Agents / adverse effects*
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Conjunctivitis, Allergic / complications
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Conjunctivitis, Allergic / drug therapy*
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Cushing Syndrome / chemically induced*
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Cushing Syndrome / pathology
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Cytochrome P-450 CYP3A Inhibitors / administration & dosage
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Cytochrome P-450 CYP3A Inhibitors / adverse effects
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Drug Interactions
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HIV Infections / complications
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HIV Infections / drug therapy*
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HIV Protease Inhibitors / administration & dosage
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HIV Protease Inhibitors / adverse effects*
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Humans
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Male
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Ritonavir / administration & dosage
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Ritonavir / adverse effects*
Substances
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Adrenal Cortex Hormones
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Anti-Inflammatory Agents
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Cytochrome P-450 CYP3A Inhibitors
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HIV Protease Inhibitors
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Ritonavir