J Korean Endocr Soc.  2008 Feb;23(1):44-50. 10.3803/jkes.2008.23.1.44.

A Case of Pneumocystis Carinii Pneumonia and Cutaneous Nocardiosis Associated with Ectopic ACTH Syndrome

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea, Korea.

Abstract

Cushing's syndrome is characterized by hypercortisolism and impairment of cell-mediated immune function, increasing the risk of opportunistic infection, as occurs in other immunocompromised groups such as organ transplant recipients, patients with lymphoreticular malignancy, or acquired immunodeficiency syndrome. We report a case of a 68-year-old woman who was affected with pneumocystis carinii pneumonia (PCP) 8 years ago and cutaneous nocardiosis this year. The patient was diagnosed with ectopic ACTH syndrome 8 years ago, but no ectopic ACTH secreting focus was found in radiologic imaging studies. She recovered from PCP and cutaneous nocardiosis after antibiotic (trimethoprim-sulfamethoxazole) administration. After the infection resolved, she underwent laparoscopic bilateral adrenalectomy and was not longer hypercortisolemic.

Keyword

ectopic ACTH syndrome; pneumocystis carinii pneumonia; nocardiosis

MeSH Terms

Acquired Immunodeficiency Syndrome
ACTH Syndrome, Ectopic
Adrenalectomy
Adrenocorticotropic Hormone
Aged
Cushing Syndrome
Female
Humans
Nocardia Infections
Opportunistic Infections
Pneumocystis
Pneumocystis carinii
Pneumonia, Pneumocystis
Transplants
Adrenocorticotropic Hormone
Nocardia Infections

Figure

  • Fig. 1 Chest CT shows focal peripheral consolidation in posterior subpleura of right upper lobe (arrow).

  • Fig. 2 Abdominal CT shows bilateral adrenal hyperplasia.

  • Fig. 3 Sella MRI shows a 5.6 mm sized lesion in left anteroinferior aspect of the sella suggesting microadenoma (B, arrow). Compared to the size measured 4 years ago (A, arrow), there has been no significant interval change.

  • Fig. 4 Ultrasonography (A) and MRI (B, C) show an irregular shaped heterogenous lesion in the epichondylar region of right elbow, suggesting infectious lymphadenitis with necrotic change and surrounding cellulitis (arrow).

  • Fig. 5 The changes of serum cortisol (µg/dL), 24hr urine free cortisol (µg/day) and the dosage of ketoconazole.


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