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

Naohiro Oda; Nobuaki Miyahara; Masahiro Tabata; Daisuke Minami; Kiichiro Ninomiya; Arihiko Kanehiro; Motoshi Komatsubara; Kenichi Inagaki; Mitsune Tanimoto; Katsuyuki Kiura

doi:10.2169/internalmedicine.56.7655

CASE REPORTS

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

Naohiro Oda, Nobuaki Miyahara, Masahiro Tabata, Daisuke Minami, Kiichiro Ninomiya, Arihiko Kanehiro, Motoshi Komatsubara, Kenichi Inagaki, Mitsune Tanimoto, Katsuyuki Kiura

Author information

Naohiro Oda
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Nobuaki Miyahara
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Department of Medical Technology, Okayama University Graduate School of Health Sciences, Japan
Masahiro Tabata
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Daisuke Minami
Department of Respiratory Medicine, NHO Okayama Medical Center, Japan
Kiichiro Ninomiya
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Arihiko Kanehiro
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Motoshi Komatsubara
Endocrine Center, Okayama University Hospital, Japan
Kenichi Inagaki
Endocrine Center, Okayama University Hospital, Japan
Mitsune Tanimoto
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
Katsuyuki Kiura
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan

Keywords: ectopic ACTH syndrome, Cushing's syndrome, thymus, neuroendocrine tumor, large cell neuroendocrine carcinoma, pneumocystis pneumonia

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 5 Pages 551-555

DOI https://doi.org/10.2169/internalmedicine.56.7655

Details

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.

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