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

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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
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2008; 23(1): 44-50.

Published online: 20 February 2008

DOI: https://doi.org/10.3803/jkes.2008.23.1.44

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

Hee-Sun Jung, Seung-Hwan Lee, Hee-Yeon Kim, Eun-Ho Chu, Kang-Woo Lee, Mi-Ja Kang, Ji-Hyun Kim, Hyuk-Sang Kwon, Kun-Ho Yoon, Bong-Yun Cha, Ho-Young Son

Department of Internal Medicine, The Catholic University of Korea, Korea.

Received 1 October 2007       Accepted 27 December 2007

Copyright © 2008 Korean Endocrine Society

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.

Keywords: ectopic ACTH syndrome, pneumocystis carinii pneumonia, nocardiosis

Figures and Tables

Fig. 1
Chest CT shows focal peripheral consolidation in posterior subpleura of right upper lobe (arrow).
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Fig. 2
Abdominal CT shows bilateral adrenal hyperplasia.
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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.
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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).
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Fig. 5
The changes of serum cortisol (µg/dL), 24hr urine free cortisol (µg/day) and the dosage of ketoconazole.
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Table 1
The results of low dose and high dose dexamethasone suppression test (DST)
jkes-23-44-i001

UFC, urine free cortisol.

Table 2
The concentration of ACTH (pg/mL) during inferior petrosal sinus sampling
jkes-23-44-i002

CRH was administered at 0 min.

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