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Date Published: 25/05/2024
Abstract Views: 184
Views PDF: 117
DOI: https://doi.org/10.59873/vjid.v2i46.361
Issue
Vol. 2 No. 46 (2024)
Section
Scientific research
How to Cite
Du, T. D., Vo, T. L., Ho, N. N. P., Nguyen, T. N. Q., Dao, N. B. T., Nguyen, H. D., Ho, D. T. N., & Nguyen, L. N. T. (2024). ADRENAL INSUFFICIENCY IN A HIV-INFECTED PATIENT DIAGNOSID WITH CRYPTOCOCCAL MENINGITIS: A CASE REPORT AND LITERATURE REVIEW. Vietnam Journal of Infectious Diseases, 2(46), 18-24. https://doi.org/10.59873/vjid.v2i46.361

ADRENAL INSUFFICIENCY IN A HIV-INFECTED PATIENT DIAGNOSID WITH CRYPTOCOCCAL MENINGITIS: A CASE REPORT AND LITERATURE REVIEW

Trong Duc Du, Trieu Ly Vo, Nguyen Ngoc Phuong Ho, Thi Nhu Quynh Nguyen, Nguyen Bao Tran Dao, Hong Dao Nguyen, Dang Trung Nghia Ho, Le Nhu Tung Nguyen

Main Article Content

Abstract

Introduction: Although adrenal insufficiency is not an uncommon problem in persons living with HIV, it is often
unnoticed in clinical practice. In addition to causes due to opportunistic infections, some kinds of treatment may
promote or lead to adrenal suppression.
Methods: A descriptive case report and literature review.
Case presentation: A 48-year-old man who was diagnosed with HIV/AIDS and received ARV treatment (acriptega) one and a half months ago was admitted because of prolonged headache and fever. As a result, his diagnosis was Cryptococcus neoformans meningitis, so he was treated with amphotericin B infusion and oral high dose fluconazol. After 14 days of induction phase, fungal CSF culture was negative. However, this patient had fever,
nausea, indigestion and neurological deterioration (confusion, expressive aphasia). At that time, he had prolonged hyponatremia, eosinophilia and high level of C-reactive protein. The kinetics of his basal morning plasma cortisone showed a decreasing trend. His situation improved significantly with intravenous hydrocortison.
Discussions: Even though ACTH stimulate test was not performed, his symptoms and low level of morning
plasma cortisone were consistent with adrenal insufficiency. His response to intravenous hydrocortison contributed to strengthening the diagnosis. 
Conclusions: Adrenal insufficiency is the diagnosis should be considered in elderly patients with suggested symptoms. Despite the fact that it is rare, high dose fluconazol maybe a culprit leads to adrenal suppression.
Therefore, physicians need to pay attention to this drug as a cause of adrenal insufficiency.

Article Details

Keywords

Adrenal insufficiency, fluconazol, Cryptococcus, meningitis, cortisol

References

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