Iatrogenic Cushing's syndrome in a case of allergic bronchopulmonary aspergillosis treated with oral itraconazole and inhaled budesonide.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that occurs in patients with asthma or cystic fibrosis. Here, we report a case of a young female with bronchial asthma who presented to our hospital with worsening breathlessness on exertion. She was diagnosed to have ABPA and was initiated on oral itraconazole while continuing inhaled long acting beta-2 adrenergic agonist and medium dose inhaled corticosteroid (ICS) for her asthma. Three months after initiation of therapy, the patient had significant improvement in breathlessness. However, she had weight gain, facial puffiness, increased facial hair and development of striae on her inner thighs, calf and lower abdomen. Her serum cortisol levels were found to be suppressed and hence a diagnosis of iatrogenic Cushing's syndrome was made. Our case describes the potentially serious interaction between ICS and oral itraconazole, a treatment very commonly prescribed in patients with ABPA.

Association of Non-HDL Cholesterol, Homocysteine and Vitamin D in Acute Coronary Syndrome.

BACKGROUND: The role of Low Density Lipoprotein Cholesterol (LDL-C) in the pathogenesis of Coronary Heart Disease (CHD) has been well established. In many studies it was found that Non-HDL cholesterol (total cholesterol minus High Density Lipoprotein Cholesterol [HDL-C] is a better predictor of CHD risk than LDL-C alone. High homocysteine levels are associated with increased risk of cardiovascular and cerebrovascular disease. An inverse relation has been seen between vitamin D serum level and coronary artery calcification. Studies are inadequate among Indians to establish the role of these non-conventional risk factors in acute coronary syndrome. OBJECTIVES: To correlate the values of non-HDL cholesterol, vitamin D and homocysteine in patients with acute coronary syndrome (ACS) with controls. METHODS: :For this retrospective study cases were the patients admitted in Poona Hospital and Research Centre between November 2013 and November 2015 with acute coronary syndrome whereas controls were patients admitted in Poona Hospital and Research Centre during the same period with diagnosis other than Acute coronary syndrome. Each patient was subjected to detailed clinical history, clinical examination and investigations such as lipid profile, serum homocysteine, and Vitamin D3. Unpaired t-test was used to compare the quantitative data whereas Chi-square test or Fisher's exact test was used for qualitative data. RESULTS: ACS group had significantly higher mean total serum cholesterol, mean LDL cholesterol, mean non-HDL cholesterol, and mean plasma homocysteine as compared to control group. However, there was no statistically significant difference between the two groups in Vit D levels. Odds ratio was maximum for Non HDL cholesterol, followed by LDL cholesterol, HDL cholesterol, Serum Homocysteine, and Total cholesterol. CONCLUSION: Non-HDL cholesterol was a better predictor of cardiovascular diseases than LDL-C, HDL-C or total cholesterol.