Vertebral compression fractures in an HIV-positive patient with steroid-induced Cushing syndrome: a case report

Leitman, David; Ross, Kenneth A.

doi:10.4076/1757-1626-2-7034

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Prolonged cortisone therapy can induce osteoporosis [ 20 ] by multiple mechanisms, including bone mineral density loss and alteration of bone quality [ 21 ] in direct relation with dosage and treatment duration. Protease inhibitors are also involved in adverse bone effects, and evidence abounds in this direction.…”

Section: ⧉ Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report

Chiperi¹,

Ionescu²,

Marcu³

et al. 2021

Rom J Morphol Embryol

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Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition and furthermore human immunodeficiency virus (HIV)-associated HLH is rarely reported in the literature. The most frequent presentation of secondary HLH is in association with infections, malignancies or drugs. In HIV-positive patients, the viral infection itself or the antiretroviral therapy (ART) could trigger HLH. Case presentation: A 14-year-old boy was admitted for persistent diarrhea, severe weight loss and chest burns. Laboratory tests revealed important neutropenia, which led to HIV infection diagnosis. ART in combination was started associated with granulocyte-colony stimulating factor. Viral copies declined after six weeks of treatment, but the cluster of differentiation 4 (CD4) T-lymphocytes and neutrophil counts remained very low. Infections and malignancies were ruled out. The bone marrow aspirate revealed hemophagocytosis which in association with fever, bicytopenia, hypofibrinogenemia and hypertriglyceridemia established HLH diagnosis. Cortisone therapy and intravenous immunoglobulins were added. Due to lack of response, HLH-2004 protocol was initiated in collaboration with pediatric hematologist. In the first six months of treatment, CD4 T-lymphocytes and neutrophil count remained low and then they showed significant increase simultaneously. During treatment, the patient developed spontaneous severe back pain. Magnetic resonance imaging showed vertebral compression, osteomalacia and a thoracic vertebral fracture. Conclusions: Having ruled out the usual associated infections and malignancies, this is a case of HIV-associated with HLH. In this case, only the ART and immunomodulatory therapy were not enough and failed to work. Systemic immunosuppression also worked only after a prolonged course which led to an unfortunate complication: a vertebral fracture.

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Section: ⧉ Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report

Chiperi¹,

Ionescu²,

Marcu³

et al. 2021

Rom J Morphol Embryol

View full text Add to dashboard Cite

show abstract

“…Typical features include weight gain, central obesity, dorsocervical hump, moon face, facial plethora, thin skin, easy bruising, abdominal striae, hirsutism, proximal myopathy, osteopenia, glucose intolerance, hypertension, nephrolithiasis and psychiatric manifestations such as depression and psychosis (Newell-Price et al 2006 ). Osteoporosis is common and tends to involve trabecular bone resulting in an increased risk of fracture within 3 months of daily exposure (van Staa et al 2000 , 2002 , 2005 ).…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Cushing syndrome and adrenal insufficiency during concomitant therapy with ritonavir and fluticasone

Epperla

McKiernan

2015

SpringerPlus

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Ritonavir is a potent inhibitor of the cytochrome P450 enzyme CYP3A4 and is subject to multiple drug–drug interactions. This becomes especially important when the patient is also taking medications metabolized through CYP3A pathway as increased and potentially toxic drug levels may ensue. Herein we present one such interaction wherein a 57 year old gentleman with human immunodeficiency virus (HIV) infection on highly active antiretroviral therapy that included ritonavir, had addition of fluticasone inhaler to his medication repertoire for treatment of chronic obstructive pulmonary disease. This resulted in severe osteoporosis, iatrogenic Cushing syndrome and adrenal insufficiency due to the potentiated systemic glucocorticoid effect of inhaled fluticasone by ritonavir. This case emphasizes the need for pharmacovigilance when managing patients on complex drug regimens for physicians treating HIV infected patients.

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“…A review of the literature from January 1, 1995, to December 1, 2013, was conducted for relevant studies about PVP or PKP regarding glucocorticosteroid-induced osteoporotic vertebral compression fractures in the PubMed database. One hundred and seventeen patients with GIOPVCFs treated by PVP or PKP were included in the 11 eligible studies ( 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ). Fifty of 117 (42.8%) patients sustained refractures after vertebropalsty and received repeated vertebroplasty procedures, of which 24 and 26 patients underwent PKP and PVP procedures, respectively.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Vertebroplasty of the Entire Thoracic and Lumbar Vertebrae for Vertebral Compression Fractures Related to Chronic Glucocorticosteriod Use: Case Report and Review of Literature

Tian

Quanping

et al. 2014

Korean J Radiol

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Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.

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Vertebral compression fractures in an HIV-positive patient with steroid-induced Cushing syndrome: a case report

Cited by 4 publications

References 13 publications

Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report

Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report

Iatrogenic Cushing syndrome and adrenal insufficiency during concomitant therapy with ritonavir and fluticasone

Percutaneous Vertebroplasty of the Entire Thoracic and Lumbar Vertebrae for Vertebral Compression Fractures Related to Chronic Glucocorticosteriod Use: Case Report and Review of Literature

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