A Case of Cushing Syndrome With Diabetic Ketoacidosis and Invasive Pulmonary Aspergillosis

Abstract

We report the successful treatment of a 51-year-old man with diabetic ketoacidosis, invasive pulmonary aspergillosis, and Cushing syndrome. The patient was naturally healthy and had no medical examination history. He had been aware of thirst, polydipsia and polyuria for 6 months. He was taken to the hospital with sudden vomiting and impaired consciousness and was admitted with a diagnosis of diabetic ketoacidosis: blood glucose, 979 mg/dL; HbA1c, 11.5 %; arterial blood pH, 6.94; and urinary ketone, 4+. His blood glucose improved with continuous insulin infusion, but pulmonary mycosis was suspected based on a high inflammatory response and multiple pulmonary nodules with ground glass opacity, and treatment with voriconazole was started; however, the lung lesions did not show improvement. He was diagnosed with Cushing syndrome. ACTH-independent Cushing syndrome was suspected based on a plasma ACTH level of 4.2 pg/mL and a serum cortisol level of 30.7 μg/dL. Treatment for Cushing syndrome was started on the 24th day with metyrapone. In addition, we diagnosed invasive pulmonary aspergillosis based on β-D glucan positivity, aspergillus antigen positivity and CT findings. This is a valuable case of invasive pulmonary aspergillosis accompanied by hyperglycemia in which the patient was saved by treatment of Cushing syndrome.