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Reversible acute adrenal insufficiency caused by fluconazole in a critically ill patient

Department of Internal Medicine, Metropolitan Hospital Center, New York, USA

Correspondence to:
Correspondence to:
Dr S G S Krishnan
410 Lakeville Road, Suite 105, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA; sgskrishnan{at}hotmail.com

A 38 year old man with history of obstructive sleep apnea and polycythaemia presented with hypercapnic respiratory failure that required intubation. He developed fever with infiltrates on chest radiography that required empiric antifungal therapy with fluconazole along with broad spectrum antibiotics. He developed acute adrenal insufficiency that recovered after fluconazole was stopped. It is believed that this complication of adrenal suppression attributable to fluconazole is underrecognised and it may be prudent to monitor all critically ill patients who are given fluconazole for this complication.

Abbreviations: ACTH, adrenocorticotrophic hormone; CT, computed tomography; ICU, intensive care unit

Keywords: fluconazole; adrenal insufficiency