Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special

A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and sever...

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Published inJournal of fungi (Basel) Vol. 7; no. 8; p. 620
Main Authors Villar-Prados, Alejandro, Chang, Julia J., Stevens, David A., Schoolnik, Gary K., Wang, Samantha X. Y.
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 30.07.2021
MDPI
Subjects
11β-hydroxylase
Abdomen
Adrenal glands
Ankle
Antifungal agents
Cardiac stress tests
Case Report
Coccidioidomycosis
Enzymes
Fluconazole
Glucocorticoids
Hormones
Hospitals
Hydrocortisone
Hypertension
Hypokalemia
Infections
Laboratories
Nausea
Orthopedics
Pain
Patients
Posaconazole
Potassium
pseudohyperaldosteronism
Steroids
Surgeons
Toxicity
Vomiting
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ISSN2309-608X
2309-608X
DOI10.3390/jof7080620

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Summary:A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole’s mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.
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These authors contributed equally to the body of work presented.
ISSN:2309-608X
2309-608X
DOI:10.3390/jof7080620