Infantile Iatrogenic Cushing Syndrome due to Topical Steroids

Cushing syndrome is an endocrinological disorder characterized by increased free plasma glucocorticoids level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. In children, iatrogenic Cushing syndrome is the most common form of Cushing syndrome occurring in this age group. The vast majority of cases are due to oral or parenteral preparation of steroids, which are commonly prescribed for pulmonary, hematological, renal, or autoimmune pathologies. Topical preparations can rarely cause Cushing syndrome in young children, and only a few cases were reported in the literature, where the patients were older than 5 months of age. In this report, we present a three-month-old girl who developed iatrogenic Cushing syndrome due to prolonged and inappropriate use of topical clobetasol cream for napkin dermatitis.

Parenteral 5-Fluorocytosine for Candidiasis

5-Fluorocytosine (5-FC), a systemic antifungal drug, has recently been approved for oral use in North America; however, the parenteral preparation remains an investigational drug. This report describes the use of parenteral 5-FC in nine patients with candidiasis. Six patients had invasive fungal infection and three patients had colonization. Eight patients received 5-FC intravenously and one received an intraperitoneal infusion. Of the six patients with invasive candidiasis, four received concurrent amphotericin B therapy. Candidiasis was cleared in eight of the nine patients. One patient died during therapy with combined 5-FC and amphotericin B. No clinically significant adverse effects of parenteral 5-FC were observed; however, two patients showed a transient increase in SGOT.