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However, when associated with inhibitors of this cytochrome, such as ritonavir, they may lead to iatrogenic Cushing syndrome by the systemic accumulation of corticosteroids and consequent suppression of the hypothalamic-pituitary-adrenal axis. We present a case of iatrogenic Cushing syndrome complicated by multifocal osteonecrosis in a patient with HIV infection on antiretroviral therapy with protease inhibitors boosted with ritonavir, after the association of inhaled fluticasone. This clinical case highlights a relevant interaction between corticosteroids and inhibitors of the cytochrome P450 and the severe consequences that may occur.<\/jats:p>","DOI":"10.1136\/bcr-2019-233712","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T06:26:54Z","timestamp":1590647214000},"page":"e233712","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Iatrogenic Cushing syndrome and multifocal osteonecrosis caused by the interaction between inhaled fluticasone and ritonavir"],"prefix":"10.1136","volume":"13","author":[{"given":"Joana","family":"Figueiredo","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Endocrinologia, Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarida","family":"Serrado","sequence":"additional","affiliation":[{"name":"Hospital de Santa Maria, Servi\u00e7o de 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