title: Iatrogenic Cushing's syndrome after triamcinolone plus ritonavir-boosted atazanavir.
abstract: OBJECTIVE
  To describe a case of iatrogenic Cushing's syndrome (ICS) following a triamcinolone injection for subscapular bursitis in an HIV-positive patient receiving an antiretroviral regimen that included ritonavir boosted-atazanavir.
  
  
  METHODS
  University outpatient HIV clinic.
  
  
  METHODS
  A 60-year-old HIV-positive man on a ritonavir-boosted, atazanavir-containing antiretroviral regimen was diagnosed with subscapular bursitis. The patient received two intrabursal injections with 1% lidocaine plus triamcinolone 20 mg. Four weeks after the injections, the patient experienced symptoms of Cushing's syndrome with a pronounced drop in his CD4+ T-cell count, requiring treatment of oral candidiasis and prophylaxis for opportunistic infections.
  
  
  CONCLUSIONS
  The interaction between ritonavir and oral corticosteroids, resulting in ICS, has been established. This case adds to the literature as one of the few cases illustrating that interaction can also occur between ritonavir and intrabursal administration of corticosteroids. This case further supports concerns regarding use of corticosteroids in HIV-infected patients who are treated with ritonavir-containing antiretroviral regimens.
authors: Bernadette
authors: B
authors: Jakeman
authors: Jessica
authors: J
authors: Conklin
authors: Matthew
authors: M
authors: Bouchonville
authors: Karla
authors: K
authors: Thornton
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000069446:Atazanavir Sulfate; D002062:Bursitis / Q000175:diagnosis / Q000188:drug therapy*; D018791:CD4 Lymphocyte Count; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011725:Pyridines / Q000009:adverse effects*; D012307:Risk Factors; D019438:Ritonavir / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014221:Triamcinolone / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D014221:Triamcinolone; D000069446:Atazanavir Sulfate; D019438:Ritonavir