title: Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir-boosted darunavir.
abstract: Drug interactions involving human immunodeficiency virus protease inhibitors are common due to their inhibition of the cytochrome P450 3A4 isoenzyme. We describe the case of an HIV-infected patient treated with ritonavir-boosted darunavir who developed cushingoid features following an intra-articular injection of triamcinolone acetate. We review the probable mechanism for this interaction and describe similar cases of Cushing syndrome in patients receiving concomitant ritonavir and triamcinolone.
authors: Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors: Jill J
authors: JJ
authors: Hall
authors: Christine A
authors: CA
authors: Hughes
authors: Michelle M
authors: MM
authors: Foisy
authors: Stan
authors: S
authors: Houston
authors: Stephen
authors: S
authors: Shafran
mesh_terms: D003480:Cushing Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000069454:Darunavir; D004347:Drug Interactions; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D007049:Iatrogenic Disease; D007270:Injections, Intra-Articular / Q000009:adverse effects; D008875:Middle Aged; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use*; D020069:Shoulder Pain / Q000188:drug therapy*; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D005938:Glucocorticoids; D017320:HIV Protease Inhibitors; D013449:Sulfonamides; D014221:Triamcinolone; D019438:Ritonavir; D000069454:Darunavir
keywords: AIDS; Cushing syndrome; HIV; HIV protease inhibitors; antiretrovirals; cobicistat; corticosteroids; drug interactions; ritonavir; toxicity; triamcinolone