Authors :
Dr. Praveen Singaram; Dr. K.Nagarajan
Volume/Issue :
Volume 9 - 2024, Issue 7 - July
Google Scholar :
https://tinyurl.com/5n6ucnj8
Scribd :
https://tinyurl.com/y9hmthem
DOI :
https://doi.org/10.38124/ijisrt/IJISRT24JUL785
Abstract :
An Interesting Case of Cushing Syndrome
A 36 year old female presented to dermatology
department with Multiple ulcers present in B/L axilla,
B/L inframammary fold and B/L gluteal fold (Left >
Right) since 3 months.
Patient was referred from dermatology department
to General Medicine for opinion on puffiness of face and
swelling of legs . Patient had history of topical steroid use
for itchy lesions in B/L axilla and inframammary folds 4
months back . H/o weight gain present. (6 kg). H/o
puffiness of face and striae present over the abdomen.
Patient had no known comorbidities previously. On
physical examination patient had moon face ,facial
plethora + ,Buffalo hump ,Loss of axillary hair,
centripetal obesity , Abdominal striae , Sparse pubic hair ,
Pallor +.
Systemic examination was normal. Investigations
revealed new onset diabetes , serum cortisol was low (<0.5
mcg/ml) , serum acth was low (1pg/ml) , HB was low
(7.9gm/dl) , total count was elevated (15,600) . Patient was
diagnosed to have Iatrogenic (Topical steroid induced)
Cushing Syndrome with Steroid induced atrophy and
ulceration of skin & subcutaneous tissue leading to
secondary fungal and bacterial infection , tinea incognito
with secondary bacterial infection , iron deficiency
anemia and newly detected Type 2 Diabetes mellitus.
Patient was appropiately treated with iv antibiotics (Inj
Piperacillin Tazobactum 4.5 g iv thrice daily), daily
dressing on other supportive measures along with
discontinuation of steroids. Patient improved
symptomatically after discontinuing topical steroids, the
cushingoid features started decreasing. The ulcers also
started to heal. The patient was started on Tab.
Hydrocortisone 10mg - 0 – 5mg and was referred for
Endocrinologist opinion
References :
- Wiebke Arlt, Disorders of adrenal cortex, In: Jameson Fauci, Kasper Hauser, Longo Loscalzo, Harrison’s principles of Internal medicine, 20th edition, Mc Graw Hill, 2018, pages 2719 - 2728
- Sahıp B, Celık M, Ayturk S, Kucukarda A, Mert O, Dıncer N, Guldıken S, Tugrul A. Iatrogenic Cushing's syndrome after topical steroid therapy for psoriasis. Indian Journal of Dermatology. 2016 Jan;61(1):120
- Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids. Indian journal of dermatology. 2014 Sep;59(5):460
- Bhusal M, Aryal E, Bhattarai S, Shrestha SB, Rajouria A. Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report. Nepal Journal of Dermatology, Venereology & Leprology. 2019 Mar 31;17(1):73-5
- Decani S, Federighi V, Baruzzi E, Sardella A, Lodi G. Iatrogenic Cushing's syndrome and topical steroid therapy: case series and review of the literature. Journal of Dermatological Treatment. 2014 Dec 1;25(6):495-500
- Woods DR, Arun CS, Corris PA, Perros P. Cushing's syndrome without excess cortisol. Bmj. 2006 Feb 23;332(7539):469-70
An Interesting Case of Cushing Syndrome
A 36 year old female presented to dermatology
department with Multiple ulcers present in B/L axilla,
B/L inframammary fold and B/L gluteal fold (Left >
Right) since 3 months.
Patient was referred from dermatology department
to General Medicine for opinion on puffiness of face and
swelling of legs . Patient had history of topical steroid use
for itchy lesions in B/L axilla and inframammary folds 4
months back . H/o weight gain present. (6 kg). H/o
puffiness of face and striae present over the abdomen.
Patient had no known comorbidities previously. On
physical examination patient had moon face ,facial
plethora + ,Buffalo hump ,Loss of axillary hair,
centripetal obesity , Abdominal striae , Sparse pubic hair ,
Pallor +.
Systemic examination was normal. Investigations
revealed new onset diabetes , serum cortisol was low (<0.5
mcg/ml) , serum acth was low (1pg/ml) , HB was low
(7.9gm/dl) , total count was elevated (15,600) . Patient was
diagnosed to have Iatrogenic (Topical steroid induced)
Cushing Syndrome with Steroid induced atrophy and
ulceration of skin & subcutaneous tissue leading to
secondary fungal and bacterial infection , tinea incognito
with secondary bacterial infection , iron deficiency
anemia and newly detected Type 2 Diabetes mellitus.
Patient was appropiately treated with iv antibiotics (Inj
Piperacillin Tazobactum 4.5 g iv thrice daily), daily
dressing on other supportive measures along with
discontinuation of steroids. Patient improved
symptomatically after discontinuing topical steroids, the
cushingoid features started decreasing. The ulcers also
started to heal. The patient was started on Tab.
Hydrocortisone 10mg - 0 – 5mg and was referred for
Endocrinologist opinion
