Pneumocystis Pneumonia Concomitant with Ectopic ACTH Syndrome Caused by a Large Cell Neuroendocrine Carcinoma of the Thymus.

Abstract

We herein report the case of a 44-year-old man who was diagnosed with pneumocystis pneumonia (PCP) concomitant with ectopic adrenocorticotropic hormone (ACTH) syndrome, which had been caused by a large cell neuroendocrine carcinoma of the thymus. Chest computed tomography revealed ground-glass opacities in the lungs. PCP was diagnosed by a polymerase chain reaction with bronchoalveolar lavage. The levels of cortisol were slowly corrected with an adrenal enzyme inhibitor, and the exacerbation of PCP was successfully avoided. Our case indicates that in addition to prophylaxis, the early diagnosis of PCP and the slow correction of hypercortisolemia should be considered in order to prevent an exacerbation due to the reconstitution of the immune function in patients with ectopic ACTH syndrome.

• Authors: Naohiro Oda, Nobuaki Miyahara, Masahiro Tabata, Daisuke Minami, Kiichiro Ninomiya, Arihiko Kanehiro, Motoshi Komatsubara, Kenichi Inagaki, Mitsune Tanimoto, Katsuyuki Kiura
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 56 Issue 5 Pg. 551-555 ( 2017) ISSN: 1349-7235 [Electronic] Japan
• PMID: 28250304 (Publication Type: Case Reports, Journal Article)

Chemical References

• Enzyme Inhibitors
• Hydrocortisone
• Metyrapone

Topics

• ACTH Syndrome, Ectopic (complications, drug therapy)
• Adult
• Bronchoalveolar Lavage
• Carcinoma, Neuroendocrine (complications)
• Early Diagnosis
• Enzyme Inhibitors (therapeutic use)
• Humans
• Hydrocortisone (blood)
• Male
• Metyrapone (therapeutic use)
• Opportunistic Infections (complications, diagnosis)
• Pneumonia, Pneumocystis (complications, diagnosis)
• Thymus Neoplasms (complications)
• Tomography, X-Ray Computed