Pneumocystis Carinii Pneumonia in Ectopic Adrenocorticotrophic Hormone Syndrome: A Case Report and Literature Review

  Objective  To analyze the clinical features and therapy of patients with ectopic adrenocorticotrophic hormone (ACTH) syndrome and pneumocystis carinii pneumonia (PCP).

  Methods  A retrospective study was conducted on one patient of ectopic ACTH syndrome with PCP diagnosed and treated in Peking Union Medical College Hospital. Relevant literature was reviewed.

  Results  The patient was a 52-year-old woman presented with central obesity and weakness. Laboratory investigations revealed marked elevations of plasma ACTH and cortisol levels. A diagnosis of ectopic ACTH syndrome based on a carcinoid tumor in her right lung was made. The symptoms of complicated PCP occurred shortly after the resection of the tumor that caused ACTH syndrome and the reduction of plasma ACTH and cortisol levels, which were mainly fever, nonproductive cough, and shortness of breath. The patient recovered after the treatment of sulfamethoxazole and glucocorticoid.

  Conclusions  PCP is a severe opportunistic infection in ectopic ACTH syndrome. Patients with higher cortisol level may at a higher risk of pneumocystis carinii infection. Clinical symptoms of PCP may be present after initiation of treatment, reduction of cortisol level, and recovery of immune functions. Early identification of etiological mechanism and prophylactic treatment for PCP may improve the prognosis of ACTH patients with PCP.