Addisonian crisis in a liver transplant patient due to fluconazole withdrawal

Fluconazole is an antifungal agent commonly used, in liver transplant patie nts. In addition to its antifungal activity, it is a potent inhibitor of th e liver cytochrome P450 enzymes. These enzymes degrade a wide range of meta bolically active compounds including glucocorticoids. In this report, we id entify an episode of Addisonian crisis that occurred in a liver transplant patient receiving prednisone immunosuppression after fluconazole was discon tinued. We postulate the mechanism for the crisis was a reversal of the flu conazole-induced suppression of the P450 enzymes, The resulting increased a ctivity altered the patient's glucocorticoid metabolism leading to an Addis onian crisis.