Ritonavir and Topical Ocular Corticosteroid Induced Cushing's Syndrome in an Adolescent With HIV-1 Infection

Pediatr Infect Dis J. 2017 May;36(5):502-503. doi: 10.1097/INF.0000000000001534.

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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects*
  • Conjunctivitis, Allergic / complications
  • Conjunctivitis, Allergic / drug therapy*
  • Cushing Syndrome / chemically induced*
  • Cushing Syndrome / pathology
  • Cytochrome P-450 CYP3A Inhibitors / administration & dosage
  • Cytochrome P-450 CYP3A Inhibitors / adverse effects
  • Drug Interactions
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / administration & dosage
  • HIV Protease Inhibitors / adverse effects*
  • Humans
  • Male
  • Ritonavir / administration & dosage
  • Ritonavir / adverse effects*

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Cytochrome P-450 CYP3A Inhibitors
  • HIV Protease Inhibitors
  • Ritonavir