Glucocorticoids and invasive fungal infections

Lancet. 2003 Nov 29;362(9398):1828-38. doi: 10.1016/S0140-6736(03)14904-5.


Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing's syndrome and, much more frequently, those receiving exogenous glucocorticoid therapy, are especially at risk of such infections. This vulnerability is attributed to the complex dysregulation of immunity caused by glucocorticoids. We critically review the spectrum and presentation of invasive fungal infections that arise in the setting of hypercortisolism, and the ways in which glucocorticoids contribute to their pathogenesis. A better knowledge of the interplay between glucocorticoid-induced immunosuppression and invasive fungal infections should assist in earlier recognition and treatment of such infections. Efforts to decrease the intensity of glucocorticoid therapy should help to improve outcomes of opportunistic fungal infections.

Publication types

  • Review

MeSH terms

  • Adrenocortical Hyperfunction / blood
  • Adrenocortical Hyperfunction / chemically induced
  • Adrenocortical Hyperfunction / complications
  • Antibody Formation / drug effects
  • Cushing Syndrome / drug therapy
  • Glucocorticoids / adverse effects*
  • Glucocorticoids / therapeutic use
  • Humans
  • Hydrocortisone / adverse effects
  • Hydrocortisone / blood
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Mycoses / chemically induced*
  • Mycoses / immunology
  • Opportunistic Infections / chemically induced
  • Opportunistic Infections / drug therapy*
  • Opportunistic Infections / immunology


  • Glucocorticoids
  • Immunosuppressive Agents
  • Hydrocortisone