A case of Addisonian crisis, acute renal failure, vesiculobullous rash, rhabdomyolysis, neurological disturbances and prolonged viraemia in a patient on long term steroids.

摘要

In February 2009, Mr. AL, a 54 year old man presented to our hospital with a two day history of fever, chills and generalised weakness associated with headache and vomiting. He had no joint symptoms. His past medical history include Addison's disease diagnosed in 1992 of which inflammatory, infective and malignant causes were excluded. He has since been on long term hydrocortisone lOmg three times a day and fludrocortisone 0.15 mg daily. He also has hypertension on diet control and hyperuricemia on allopurinol 200 mg daily. Prior to his admission, he had no recent travel history and no contact with animals. There was no change in his medications. His wife was recently admitted to another hospital for viral fever associated with arthralgia. On admission, he was confused. His body temperature was 39.5 °C, pulse rate was 124/min, in sinus tachycardia and blood pressure was 75/45 mmHg. He had developed a generalised maculopapular rash. There were patches of vesiculobullous lesions over his abdomen and patches of purpuric erythema over his limbs.