Journal List > J Korean Endocr Soc > v.23(1) > 1003472

Jung, Lee, Kim, Chu, Lee, Kang, Kim, Kwon, Yoon, Cha, and Son: A Case of Pneumocystis Carinii Pneumonia and Cutaneous Nocardiosis Associated with Ectopic ACTH Syndrome


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.

Figures and Tables

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.
Table 1
The results of low dose and high dose dexamethasone suppression test (DST)

UFC, urine free cortisol.

Table 2
The concentration of ACTH (pg/mL) during inferior petrosal sinus sampling

CRH was administered at 0 min.


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