title: Fatal cytomegalovirus-associated adrenal insufficiency in an AIDS patient receiving corticosteroid therapy.
abstract: A 35-year-old homosexual man, who had already received sulfamethoxazole/trimethoprim and steroid therapy because of human immunodeficiency virus (HIV)-related Pneumocystis jiroveci pneumonia, was referred to our hospital. He was also diagnosed as having cytomegalovirus (CMV) co-infection, and started receiving intravenous gancyclovir for CMV infection on the 2nd day of admission into our hospital. He had to continue the steroid therapy because his respiratory condition did not improve. On the 10th hospitalization day, when 40 mg of prednisolone was administered, cardiopulmonary arrest suddenly occurred, and his laboratory data showed hyponatremia and hyperpotassemia. In spite of resuscitation, he died two days later. The postmortem examination revealed that he died of adrenal failure due to CMV infection. In general, CMV is thought to cause adrenalitis, but rarely leads to manifestations of adrenal insufficiency during the clinical course. It is important to be aware that grave adrenal failure due to CMV infection can develop even under steroid therapy.
authors.affiliation: Center for Infectious Diseases, Nara Medical University, Nara, Japan. ukenji@naramed-u.ac.jp <ukenji@naramed-u.ac.jp>
authors.forename: Kenji
authors.initials: K
authors.lastname: Uno
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Konishi
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yoshimoto
authors.forename: Kei
authors.initials: K
authors.lastname: Kasahara
authors.forename: Kei
authors.initials: K
authors.lastname: Mori
authors.forename: Koichi
authors.initials: K
authors.lastname: Maeda
authors.forename: Eiwa
authors.initials: E
authors.lastname: Ishida
authors.forename: Noboru
authors.initials: N
authors.lastname: Konishi
authors.forename: Koichi
authors.initials: K
authors.lastname: Murakawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mikasa
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy*; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D017809:Fatal Outcome; D015774:Ganciclovir / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D008297:Male; D009336:Necrosis; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000821:virology; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012151:Resuscitation
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D011239:Prednisolone; D015774:Ganciclovir