ritonavir and Conjunctivitis--Allergic

Cushing's syndrome after topical ocular corticosteroid use is extremely rare. We describe a case of symptomatic Cushing's syndrome in an adolescent male with sight-threatening vernal keratoconjunctivitis on antiretroviral therapy for HIV-1 infection that included ritonavir, a potent cytochrome p450 CYP3A4 inhibitor. CYP3A4 inhibition reduces the metabolism of exogenous corticosteroids leading to suppression of endogenous steroid production and Cushing's syndrome.

Topics: Adolescent; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Conjunctivitis, Allergic; Cushing Syndrome; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; HIV Infections; HIV Protease Inhibitors; Humans; Male; Ritonavir