Artri King induced Cushing syndrome in an 82-year-old man

An 82-year-old man with a history of hypertension, thyroid nodule, and parkinsonism on carbidopa/levodopa was referred for a sudden eruption of scattered purpuric macules. He noted fatigue, weakness, ankle swelling, abdominal fullness, headaches, lapses in memory, and dysphasia. On physical examination, he had thin and atrophied upper extremities and central obesity, as well as nonblanching red to purple macules on the lower abdomen and ecchymosis on bilateral arms. The patient denied the use of any corticosteroids. Lab workup showed an abnormally high post-dexamethasone cortisol level, which raised suspicion for Cushing syndrome. Further inquiry into the patient's medication and supplement history revealed that he was consuming Artri King, a supplement marketed for the treatment of joint pain and arthritis. Artri King can lead to numerous dermatological manifestations akin to endogenous Cushing syndrome such as thin skin, easy bruising, and purple striae. This case illustrates the potential risks of over-the-counter dietary supplements, which often circumvent the strict Food and Drug Administration regulations applied to prescription medications, posing significant health hazards to users. There is critical need for transparency and regulation of supplements.