Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Horm Res 2005;64:35–38 DOI: 10.1159/000087288 Fatal Disseminated Cytomegalovirus Infection in an Infant with Cushing’s Syndrome Caused by Topical Steroid Ayla Güven a Sule Karadeniz a Oguz Aydin b Mehtap Akbalik a Murat Aydin a Departments of a Pediatrics and b Pathology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey It is well known that glucocorticoids suppress immu- nological responses in several ways. Glucocorticoids re- duce lymphocyte counts by redistributing lymphocytes from the intravascular compartment to spleen, lymph nodes, and bone marrow [8]. The immunological actions of glucocorticoids involve direct actions on both T and B lymphocytes that include inhibition of immunoglobulin synthesis and stimulation of lymphocyte apoptosis [9]. Cytomegalovirus (CMV) in infancy may be asymp- tomatic or present with rash, jaundice, hepatosplenomeg- aly or microcephaly [10]. Disseminated CMV infection is usually observed in patients with immunodeficiency [11] . When used in a high dose and for a long time, topi- cal steroids can cause immunodeficiency. We report a case of disseminated CMV infection in a 3-month-old girl with Cushing’s syndrome caused by ex- ogenous topical glucocorticoid application, which might have caused immunosuppression due to prolonged use. Case Report A 3-month-old girl was admitted to hospital for restlessness and plumpness of her cheeks. She was the first child of second-degree consanguineous parents. Pregnancy and delivery were uneventful and her birth weight was 2,700 g. The patient had a history of dia- per dermatitis since birth. Key Words Cushing’s syndrome  Cytomegalovirus infection  Clobetasol propionate  Fatty liver Abstract 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. Copyright © 2005 S. Karger AG, Basel Cushing’s syndrome in pediatric patients is usually caused by adrenal tumors or pituitary adenoma [1–3]. It is also very rare in infancy. However, topical application of potent corticosteroids can cause Cushing’s syndrome, as well as suppression of the hypothalamic-pituitary-ad- renal axis [4–7]. Sufficient exogenous glucocorticoids can be absorbed through the skin and can result in Cushing’s syndrome. Clobetasol propionate (0.05%) is the most po- tent topical corticosteroid available and there are reports of adrenal suppression due to its prolonged use [4–6]. Received: March 21, 2005 Accepted: May 18, 2005 Published online: August 2, 2005 HORMONE RESEARCH Dr. Ayla Güven Ondokuz Mayıs Universitesi Tıp Fakültesi Pediatrik Endokrinoloji Bilim Dalı, Kurupelit TR–55200 Samsun (Turkey) Tel. +90 362 4576000, Fax +90 362 4576041, E-Mail aylaguven@yahoo.com © 2005 S. Karger AG, Basel 0301–0163/05/0641–0035$22.00/0 Accessible online at: www.karger.com/hre