Topical-steroid-induced iatrogenic Cushing syndrome in the pediatric age group: A rare case report
A 5-month-old female was admitted in our hospital for complaint of fever, cough, increased rate of breathing since 1 month. The patient also had a complaint of swelling over face and all over the body since last 2 month.\nOn examination the patient was febrile; tachycardia and tachypnea were also there. Anemia, generalized anasarca, and hepatomegaly were the other significant findings. There were fading rashes present all over the body. Blood pressure in supine position was 84/66 mm Hg, which was above the 95th centile for this age group.\nIn the past the patient had a history of skin infection at 2 months of age after which mother took treatment from a quack who prescribed betamethasone for topical application. Since then she was applying betamethasone ointment on the whole body.\nIn laboratory findings the patient found to have decreased hemoglobin (8 g%), raised total leukocyte count (12,000) with raised polymorphs (80%), abnormal liver function (SGPT-1100, SGOT 700), hyperglycemia (serum glucose 164 mg%), abnormal coagulation profile (INR 1.7), normal renal function and urinalysis.\nSerum cortisol was raised [34.95 mcg/dl (normal 3-5 mcg/dl)] eight times the baseline value for this age;[] a dexamethasone test was negative.\nUltrasound abdomen showed hepatomegaly with minimal ascite; no suprarenal mass was reported. Transcranial ultrasound and neuroimaging of the brain were within normal limits. Dermatology opinion was taken and the patient was diagnosed as seborrhic dermatitis. Treatment was started but unfortunately the child could not be saved.