Active Ingredient: Azithromycin
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By scattering photons off writer who becomes her one can sample the the shit out of everything. The patient's therapy was changed to oral clarithromycin, 500 mg b.
However, this therapy was poorly tolerated and the patient returned to the clinic with worsening subcutaneous nodules and new right olecranon bursitis.
She also had developed Candida esophagitis, which was subsequently treated with fluconazole. Therapy was changed to ciprofloxacin, 500 mg b.
Moderate improvement was noted within 2 weeks. After 3 months, bursal inflammation had resolved and only 2 nodules remained. In view of the elevated afternoon cortisol level, an endocrinologic evaluation was conducted.
Results of further tests were suggestive of Cushing's syndrome, yet inconclusive. However, the patient had severe symptomatic steroid myopathy, uncontrolled diabetes, massive mediastinal lipomatosis, and hypertension; therefore, ablative therapy was started with aminoglutethimide and supplemental low-dose hydrocortisone.
The patient's symptoms improved, but she had difficulty tolerating aminoglutethimide and it was discontinued. One year after the initial office visit the patient underwent bilateral adrenalectomy.
Pathological examination revealed bilateral adrenal hyperplasia.
The patient received azithromycin and ciprofloxacin for 2 months after the operation and the subcutaneous nodules and olecranon bursitis resolved completely. The clinical manifestations of Cushing's syndrome gradually resolved within several months after the adrenalectomy.
One year after treatment with azithromycin and ciprofloxacin was discontinued, there was no evidence of recurrent mycobacterial infection.