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      Fatal Disseminated Cytomegalovirus Infection in an Infant with Cushing’s Syndrome Caused by Topical Steroid

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          Corticosteroids, even in topical application, may cause immunosuppression and Cushing’s syndrome. A case of disseminated fatal cytomegalovirus infection is reported in a 3-month-old girl with Cushing’s syndrome caused by exogenous topical clobetasol propionate application, which might have caused immunosuppression due to prolonged use.

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          Most cited references 9

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          Endocrine withdrawal syndromes.

          Hypersecretion of endogenous hormones or chronic administration of high doses of the same hormones induces varying degrees of tolerance and dependence. Elimination of hormone hypersecretion or discontinuation of hormone therapy may result in a mixed picture of two syndromes: a typical hormone deficiency syndrome and a generic withdrawal syndrome. Thus, hormones with completely different physiological effects may produce similar withdrawal syndromes, with symptoms and signs reminiscent of those observed with drugs of abuse, suggesting shared mechanisms. This review postulates a unified endocrine withdrawal syndrome, with changes in the hypothalamic-pituitary-adrenal axis and the central opioid peptide, in which noradrenergic and dopaminergic systems of the brain act as common links in its pathogenesis. Long-term adaptations to hormones may involve relatively persistent changes in molecular switches, including common intracellular signaling systems, from membrane receptors to transcription factors. The goals of therapy are to ease withdrawal symptoms and to expedite weaning of the patient from the hormonal excess state. Clinicians should resort to the fundamentals of tapering hormones down over time, even in the case of abrupt removal of a hormone-producing tumor. In addition, the prevention of stress and concurrent administration of antidepressants may ameliorate symptoms and signs of an endocrine withdrawal syndrome.
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            Human lymphocyte subpopulations. Effect of corticosteroids.

            Normal subjects given 60 mg of prednisone orally at 8:00 a.m. developed a transient lymphopenia at 2:00 p.m. To define the populations of lymphocytes affected the number and type of lymphocytes in the peripheral blood were assayed. "Late" and "early" spontaneous sheep red blood cell rosettes were used as markers for thymus-derived (T) lymphocytes and one of its subpopulations, respectively. Receptors for aggregated gammaglobulin and complement identified bursal-equivalent or bone marrow-derived (B) lymphocytes and one of its subpopulations, respectively. 6 h after administration of 60 mg of prednisone, the blood samples showed a decrease in proportion of T cells from 69.2 +/- 2.1% to 55.9 +/- 2.8% (average +/- SE) and an increase in B-cell proportion from 21.3 +/- 2.0% to 44.8 +/- 4.1%. The changes of "early" rosettes and complement receptor lymphocytes also paralleled these. In all cases the absolute numbers of T cells and of B cells were decreased by prednisone. The density gradient distribution of the lymphocytes did not change after prednisone. These data indicate that both T and B lymphocytes are affected by the prednisone but that the T cell lymphopenia was more pronounced. The lymphopenia might reflect either sequestration in the marrow and/or transient arrest of recirculation.
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              Disseminated cytomegalovirus disease in hosts without acquired immunodeficiency syndrome and without an organ transplant.

              We describe 7 histologically proven cases of cytomegalovirus disease in patients without human immunodeficiency virus and without organ transplants, all of whom had associated comorbid conditions. Therapy with ganciclovir generally resulted in a favorable outcome.

                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                September 2005
                31 August 2005
                : 64
                : 1
                : 35-38
                Departments of aPediatrics and bPathology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
                87288 Horm Res 2005;64:35–38
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 5, References: 18, Pages: 4
                Case Report


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