A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection

Objective: The objective of this article is to report a rare case of glucocorticoid hypersensitivity syndrome, which may be associated with an underlying rubella virus infection. Case Report: A 29-year-old man showed progressive weight gain for 16 months accompanied by a moon face, enlarged dorsocer...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Zhen Zhang, MS, Ying Feng, PhD, Yang Cao, PhD, Yan Chen, MS, Fangping Li, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cushing syndrome glucocorticoid hypersensitivity hypocortisolemia rubella virus case report Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/3e055b517fd04b0793230b6caf394d69
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:3e055b517fd04b0793230b6caf394d69
record_format	dspace
spelling	oai:doaj.org-article:3e055b517fd04b0793230b6caf394d692021-11-06T04:32:55ZA Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection2376-060510.1016/j.aace.2021.06.010https://doaj.org/article/3e055b517fd04b0793230b6caf394d692021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2376060521000833https://doaj.org/toc/2376-0605Objective: The objective of this article is to report a rare case of glucocorticoid hypersensitivity syndrome, which may be associated with an underlying rubella virus infection. Case Report: A 29-year-old man showed progressive weight gain for 16 months accompanied by a moon face, enlarged dorsocervical fat pad, central obesity, and purple striae. His cortisol circadian rhythm was normal, and plasma cortisol levels at 8:00 AM fluctuated between 3.2 and 9.54 μg/dL (reference range, 4.3-22.4 μg/dL). A dexamethasone suppression test with a very low dose (0.25 mg) of dexamethasone showed a marked decrease in plasma cortisol level to 0 μg/dL. Adrenal computed tomography and pituitary magnetic resonance imaging findings were normal. The Z-score of the bone density in the lumbar spine was −4.2. The IgM antibody for the rubella virus was positive. His erythrocyte sedimentation rate was 24 mm/hour (reference range, <15 mm/hour), and the C-reactive protein level was 9.22 mg/L (reference range, <5 mg/L). After 3 months, his symptoms resolved spontaneously. The erythrocyte sedimentation rate and C-reactive protein level returned to normal. The IgM antibody for the rubella virus turned negative, whereas the IgG antibody for the rubella virus was positive. Discussion: According to the paradox between clinical manifestations and laboratory tests exogenous Cushing syndrome, cyclical Cushing syndrome, and glucocorticoid hypersensitivity syndrome all should be considered in the diagnosis. Detailed medical history inquiry, complete endocrine hormone testing, and continuous follow-up are all critical for diagnosis. Conclusion: Consequently, the patient was diagnosed with glucocorticoid hypersensitivity syndrome. This case illustrates the need to consider the possibility of glucocorticoid hypersensitivity syndrome in a patient who has the manifestations of Cushing syndrome but paradoxical hypocortisolemia, especially after rubella virus infection.Zhen Zhang, MSYing Feng, PhDYang Cao, PhDYan Chen, MSFangping Li, PhDElsevierarticleCushing syndromeglucocorticoid hypersensitivityhypocortisolemiarubella viruscase reportDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENAACE Clinical Case Reports, Vol 7, Iss 6, Pp 367-371 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cushing syndrome glucocorticoid hypersensitivity hypocortisolemia rubella virus case report Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	Cushing syndrome glucocorticoid hypersensitivity hypocortisolemia rubella virus case report Diseases of the endocrine glands. Clinical endocrinology RC648-665 Zhen Zhang, MS Ying Feng, PhD Yang Cao, PhD Yan Chen, MS Fangping Li, PhD A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
description	Objective: The objective of this article is to report a rare case of glucocorticoid hypersensitivity syndrome, which may be associated with an underlying rubella virus infection. Case Report: A 29-year-old man showed progressive weight gain for 16 months accompanied by a moon face, enlarged dorsocervical fat pad, central obesity, and purple striae. His cortisol circadian rhythm was normal, and plasma cortisol levels at 8:00 AM fluctuated between 3.2 and 9.54 μg/dL (reference range, 4.3-22.4 μg/dL). A dexamethasone suppression test with a very low dose (0.25 mg) of dexamethasone showed a marked decrease in plasma cortisol level to 0 μg/dL. Adrenal computed tomography and pituitary magnetic resonance imaging findings were normal. The Z-score of the bone density in the lumbar spine was −4.2. The IgM antibody for the rubella virus was positive. His erythrocyte sedimentation rate was 24 mm/hour (reference range, <15 mm/hour), and the C-reactive protein level was 9.22 mg/L (reference range, <5 mg/L). After 3 months, his symptoms resolved spontaneously. The erythrocyte sedimentation rate and C-reactive protein level returned to normal. The IgM antibody for the rubella virus turned negative, whereas the IgG antibody for the rubella virus was positive. Discussion: According to the paradox between clinical manifestations and laboratory tests exogenous Cushing syndrome, cyclical Cushing syndrome, and glucocorticoid hypersensitivity syndrome all should be considered in the diagnosis. Detailed medical history inquiry, complete endocrine hormone testing, and continuous follow-up are all critical for diagnosis. Conclusion: Consequently, the patient was diagnosed with glucocorticoid hypersensitivity syndrome. This case illustrates the need to consider the possibility of glucocorticoid hypersensitivity syndrome in a patient who has the manifestations of Cushing syndrome but paradoxical hypocortisolemia, especially after rubella virus infection.
format	article
author	Zhen Zhang, MS Ying Feng, PhD Yang Cao, PhD Yan Chen, MS Fangping Li, PhD
author_facet	Zhen Zhang, MS Ying Feng, PhD Yang Cao, PhD Yan Chen, MS Fangping Li, PhD
author_sort	Zhen Zhang, MS
title	A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
title_short	A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
title_full	A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
title_fullStr	A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
title_full_unstemmed	A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection
title_sort	case of glucocorticoid hypersensitivity syndrome associated with underlying rubella virus infection
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/3e055b517fd04b0793230b6caf394d69
work_keys_str_mv	AT zhenzhangms acaseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yingfengphd acaseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yangcaophd acaseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yanchenms acaseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT fangpingliphd acaseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT zhenzhangms caseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yingfengphd caseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yangcaophd caseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT yanchenms caseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection AT fangpingliphd caseofglucocorticoidhypersensitivitysyndromeassociatedwithunderlyingrubellavirusinfection
_version_	1718443847685505024

A Case of Glucocorticoid Hypersensitivity Syndrome Associated With Underlying Rubella Virus Infection

Ejemplares similares