Acta Med. 2011, 54: 127-130

https://doi.org/10.14712/18059694.2016.35

Pneumocystis Pneumonia During Medicamentous Treatment of Cushing’s Syndrome – A Description of Two Cases

Filip Gabaleca, Alžběta Zavřelováa, Eduard Havelb, Jaroslav Cerman, jr.b, Jakub Radochaa, Ioannis Sviliasa, Jan Čápa

aCharles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Second Department of Internal Medicine, Czech Republic
bCharles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Department of Surgery, Czech Republic

Received December 18, 2010
Accepted June 30, 2011

Only a few cases of pneumocystis pneumonia (PCP) in Cushing’s syndrome have been published in the literature so far. In the majority of these patients, the pneumonia occurred after reduction of the hypercortisolism with medicamentous treatment. We report two cases of PCP during conservative treatment of hypercortisolism. We describe clinical, imaging and laboratory findings in two patients and review published cases of pneumocystits pneumonia in Cushing’s syndrome. A 60-year-old woman and 20-year-old man with Cushing’s syndrome due to ectopic ACTH syndrome were treated at our department. Both developed pneumocystis pneumonia early after treatment with ketoconazole and ethomidate bromide had been introduced and the levels of cortisol rapidly decreased. PCP prophylaxis in patients with high cortisolemia should be started before treatment of hypercortisolism in current practice. Gradual lowering of plasma cortisol should also reduce the risk of infection by Pneumocystis jiroveci.

Funding

This work was supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic (N°11344-4/2010).

References

10 live references