Iatrogenic Cushing syndrome following lumbar medial branch block in a patient with HIV on ritonavir and darunavir

Abhinav Mohan; Steven Tijmes; Jackson Cohen; Elizabeth M. Sherman; Paula Eckardt

doi:10.2217/pmt-2020-0101

Iatrogenic Cushing syndrome following lumbar medial branch block in a patient with HIV on ritonavir and darunavir

Abhinav Mohan
, Steven Tijmes
, Jackson Cohen
, Elizabeth M. Sherman
, Paula Eckardt

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

We present a case report of a 62-year old female with HIV and chronic facetogenic back pain who underwent bilateral L3-L4 and L4-L5 medial branch nerve blocks using triamcinolone acetonide 80 mg. 2 weeks later she presented to the emergency department with acute anxiety/depression and was discharged with psychiatric follow-up. 2 weeks after this she presented to the outpatient HIV clinic with persistent uncontrolled depression alongside classic cushingoid features (e.g., buffalo hump, moon facies). She was diagnosed with iatrogenic Cushing syndrome caused by a drug-drug interaction between triamcinolone and ritonavir, a protease inhibitor and a CYP3A4 enzyme inhibitor. While the literature describes the interaction of ritonavir with intra-articular/intranasal/epidural triamcinolone, this is the first documented occurrence following a nerve block procedure. Symptoms resolved within 6 months alongside discontinuation of protease inhibitor therapy.

Original language	English
Pages (from-to)	381-387
Number of pages	7
Journal	Pain Management
Volume	11
Issue number	4
DOIs	https://doi.org/10.2217/pmt-2020-0101
State	Published - May 2021

Bibliographical note

Publisher Copyright:
© 2021.

Funding

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

Keywords

corticosteroids
cushing syndrome
HIV
pain management
triamcinolone

Disciplines

Anesthesiology

Access to Document

10.2217/pmt-2020-0101

Cite this

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title = "Iatrogenic Cushing syndrome following lumbar medial branch block in a patient with HIV on ritonavir and darunavir",

abstract = "We present a case report of a 62-year old female with HIV and chronic facetogenic back pain who underwent bilateral L3-L4 and L4-L5 medial branch nerve blocks using triamcinolone acetonide 80 mg. 2 weeks later she presented to the emergency department with acute anxiety/depression and was discharged with psychiatric follow-up. 2 weeks after this she presented to the outpatient HIV clinic with persistent uncontrolled depression alongside classic cushingoid features (e.g., buffalo hump, moon facies). She was diagnosed with iatrogenic Cushing syndrome caused by a drug-drug interaction between triamcinolone and ritonavir, a protease inhibitor and a CYP3A4 enzyme inhibitor. While the literature describes the interaction of ritonavir with intra-articular/intranasal/epidural triamcinolone, this is the first documented occurrence following a nerve block procedure. Symptoms resolved within 6 months alongside discontinuation of protease inhibitor therapy.",

keywords = "corticosteroids, cushing syndrome, HIV, pain management, triamcinolone",

author = "Abhinav Mohan and Steven Tijmes and Jackson Cohen and Sherman, \{Elizabeth M.\} and Paula Eckardt",

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year = "2021",

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doi = "10.2217/pmt-2020-0101",

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AU - Mohan, Abhinav

AU - Tijmes, Steven

AU - Cohen, Jackson

AU - Sherman, Elizabeth M.

AU - Eckardt, Paula

PY - 2021/5

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N2 - We present a case report of a 62-year old female with HIV and chronic facetogenic back pain who underwent bilateral L3-L4 and L4-L5 medial branch nerve blocks using triamcinolone acetonide 80 mg. 2 weeks later she presented to the emergency department with acute anxiety/depression and was discharged with psychiatric follow-up. 2 weeks after this she presented to the outpatient HIV clinic with persistent uncontrolled depression alongside classic cushingoid features (e.g., buffalo hump, moon facies). She was diagnosed with iatrogenic Cushing syndrome caused by a drug-drug interaction between triamcinolone and ritonavir, a protease inhibitor and a CYP3A4 enzyme inhibitor. While the literature describes the interaction of ritonavir with intra-articular/intranasal/epidural triamcinolone, this is the first documented occurrence following a nerve block procedure. Symptoms resolved within 6 months alongside discontinuation of protease inhibitor therapy.

AB - We present a case report of a 62-year old female with HIV and chronic facetogenic back pain who underwent bilateral L3-L4 and L4-L5 medial branch nerve blocks using triamcinolone acetonide 80 mg. 2 weeks later she presented to the emergency department with acute anxiety/depression and was discharged with psychiatric follow-up. 2 weeks after this she presented to the outpatient HIV clinic with persistent uncontrolled depression alongside classic cushingoid features (e.g., buffalo hump, moon facies). She was diagnosed with iatrogenic Cushing syndrome caused by a drug-drug interaction between triamcinolone and ritonavir, a protease inhibitor and a CYP3A4 enzyme inhibitor. While the literature describes the interaction of ritonavir with intra-articular/intranasal/epidural triamcinolone, this is the first documented occurrence following a nerve block procedure. Symptoms resolved within 6 months alongside discontinuation of protease inhibitor therapy.

KW - corticosteroids

KW - cushing syndrome

KW - HIV

KW - pain management

KW - triamcinolone

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ER -

Iatrogenic Cushing syndrome following lumbar medial branch block in a patient with HIV on ritonavir and darunavir

Abstract

Bibliographical note

Funding

ASJC Scopus Subject Areas

Keywords

Disciplines

Access to Document

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