22year old male with DRUG INDUCED CUSHINGS with suppressed HPA axis with dengue
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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.
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 other centre 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.
Patient was started on HISONE (10mg-5mg-5mg) which was then tapered to HISONE (5mg-2.5mg-2.5mg) 6 months ago :
6am 12pm 4pm
HISONE - 10mg 5mg 5mg }
tapered to { 6months ago }
HISONE - 5mg 2.5mg 2.5mg
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