22 yrs male known case of drug induced cushing with Dengue
23rd March , 2022
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A 22 year old male , who is a known case of CUSHING’s SYNDROME (drug induced) with suppressed HPA axis on hydrocortisone came to the casualty with COMPLAINTS OF:
Fever since 3 days
Vomitings since 2days
Joint pains and headache since yesterday.
History of present illness:
Patient was apparently asymptomatic way back in 2019, then he developed red itchy ring like lesion over the thigh for which he applied CLOBETA-GM For 7 months … intermittently he also took RAKTHA SODHINI SYRUP (Ayurvedic pathanjali ) 400 ml in October 2019 .
His lesions increased and blood was oozing from then and he also noticed that he was gaining weight ( 50kgs to 70kgs) .
He went to Kamineni lb nagar in October and was diagnosed with TINEA INCOGNITO for which he was prescribed XYZAL TABLETS AND EBERNET CREAM AND SEBIFIN CREAM.
Patient had fever after 5 days of using creams and anti fungals which was high grade and associated with chills and rigors and joint pains for which he was prescribed antoxid cefixime for 1 week.
At a review after 1 month for his allergy , during a follow up in December , patient gives H/O ORAL STEROID INTAKE ( HYSONE 5mg) for 6 months [ 1 -1/2-1/2 ] prescribed by endocrinologist, and was also prescribed antifungals itraconazole and ketoconazole .
The patient’s last visit to our hospital was back in October 2021 , when he came for ACTH STIMULATION TEST. ( to know 8 am CORTISOL LEVELS )
RESULTS OF PREVIOUS ACTH STIMULATION TESTS:
20th March 2020 - 11.34 microgram / DL
18th august 2020 - 10.7 micro gram /DL
28TH FEB 2021 - 8.9 MICROGRAM/ DL
Patient has been on tab. HISONE {AFTER BEING DIAGNOSED WITH IATROGENIC CUSHINGS AND ADRENAL INSUFFICIENCY } which was then tapered after getting regular serum cortisol tests.
6am 12pm 4pm
HISONE - 10mg 5mg 5mg }
tapered to { 6months ago }
HISONE - 5mg 2.5 2.5
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