Multidisciplinary diagnosis and treatment of iatrogenic Cushing syndrome in a patient with obsessive-compulsive disorder.

SUMMARY: Iatrogenic Cushing syndrome caused by topical corticosteroid preparations is only reported in infants. We describe a case in a patient with obsessive-compulsive disorder: the patient had tic disorder and obsessive-compulsive disorder, and the condition was under stable control. After the appearance of oral ulcers, the patient uncontrollably used a large amount of chlorhexidine dexamethasone membranes, resulting in iatrogenic Cushing syndrome. The fatty liver and abnormal liver function associated with Cushing syndrome led to the discontinuation of fluvoxamine and aripiprazole for obsessive-compulsive disorder. The patient's tic and compulsive symptoms worsened, and he repeatedly bit his tongue. Under multidisciplinary diagnosis and treatment in emergency department, endocrinology department, psychological department, and dentistry department, both the mental and physical symptoms were controlled and the patient's prognosis was satisfactory. Genetic testing revealed no clear abnormalities that could explain the patient's phenotype. Therefore, medication use on obsessive-compulsive disorder patients with somatic diseases should be monitored. Multidisciplinary cooperation, especially consultation liaison psychiatry in general hospitals, is essential for the diagnosis and treatment of patients with both physical and mental symptoms in general hospitals.

LEARNING POINTS: It is necessary to monitor medication use when treating OCD patients with somatic diseases. Multidisciplinary diagnosis and treatment in general hospitals are advantageous or even the only option for improving the prognosis of comorbid mental disorders and somatic diseases. Consultation liaison with psychiatry should be strengthened in general hospitals, especially in the diagnosis and treatment of diseases that are often complicated with psychological symptoms, such as in the endocrinology department.