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Pneumocystis pneumonia can complicate medical treatment of hypercortisolism even in outpatients with Cushing's disease |
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| Institution: | 1. Endocrinology Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France;2. Pharmacovigilance Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France;3. Endocrinology Unit, Annecy Genevois Hospital Centre, 1, avenue de l’Hôpital, Epagny Metz-Tessy, BP 90074, 74374 Pringy Cedex, France;1. Registre du cancer de l’Isère, Pavillon E, CHU Grenoble-Alpes, 38043 Grenoble, France;2. FRANCIM, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France;3. Registre Rhône Alpin des Cancers Thyroïdiens – Centre de médecine nucléaire et fédération d’endocrinologie, groupement hospitalier Est, hospices civils de Lyon, 69677 Lyon, France;4. Pôle d’information médicale évaluation recherche, hospices civils de Lyon, 69424 Lyon, France;5. Thyroid Cancer Registry of Marne-Ardennes, Institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France;6. Registre des tumeurs du Calvados, Centre François Baclesse, 14076 Caen, France;1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India;2. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy;3. Department of Radiology, PGIMER, Chandigarh, India;4. Department of Neurosurgery, PGIMER, Chandigarh, India;5. Department of Histopathology, PGIMER, Chandigarh, India;1. Department of Neurosurgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China;2. Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China;3. Clinical Biobank, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China;4. School of Medicine, Tsinghua University, Beijing, China;1. Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK;2. Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, San Francisco, CA 94110, USA;3. Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0560, USA |
| Abstract: | Several cases of Pneumocystosis pneumonia (PCP) have been reported in patients with hypercortisolism, mainly in patients with severe ectopic ACTH syndrome (EAS). We report 2 cases of PCP that did not develop until after starting treatment with metyrapone, one of which occurred in an outpatient with Cushing's disease (CD) without pulmonary symptoms before medical treatment for CD. Patient 1 presented as an outpatient with CD and severe hypercortisolism but nonetheless in good general condition. Treatment with metyrapone was started before pituitary surgery. Patient 2 had EAS due to prostate cancer. Respiratory failure in the two patients occurred 4 days and 30 days, respectively, after the start of metyrapone treatment. In both cases, chest CT showed bilateral interstitial infiltrates, and Pneumocystis jirovecii was found on bronchoalveolar lavage (BAL). A literature review was performed to identify risk factors for PCP in patients with CD: we identified 20 other cases of PCP in patients treated for hypercortisolism, including 16 patients with EAS. Ninety percent of patients had free urinary cortisol greater than 6 times the upper limit of normal (ULN). In conclusion, onset of PCP after initiation of anticortisolic therapy is not limited to patients with EAS, and may occur in CD patients with elevated cortisol levels, even if the patient remains in good general condition and has no pulmonary symptoms before treatment. In such patients, routine prophylactic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) should be considered. |
| Keywords: | Cushing's syndrome Pneumocystosis Metyrapone Syndrome de Cushing Pneumonie à pneumocystis Métyrapone AIDS"} {"#name":"keyword" "$":{"id":"kw0040"} "$$":[{"#name":"text" "_":"Acquired Immune Deficiency Syndrome BAL"} {"#name":"keyword" "$":{"id":"kw0050"} "$$":[{"#name":"text" "_":"Bronchoalveolar Lavage BDG"} {"#name":"keyword" "$":{"id":"kw0060"} "$$":[{"#name":"text" "_":"β-(1 3)-D-Glucan CMV"} {"#name":"keyword" "$":{"id":"kw0070"} "$$":[{"#name":"text" "_":"Cytomegalovirus CD"} {"#name":"keyword" "$":{"id":"kw0080"} "$$":[{"#name":"text" "_":"Cushing's Disease CS"} {"#name":"keyword" "$":{"id":"kw0090"} "$$":[{"#name":"text" "_":"Cushing's Syndrome EAS"} {"#name":"keyword" "$":{"id":"kw0100"} "$$":[{"#name":"text" "_":"Ectopic ACTH Syndrome FUC"} {"#name":"keyword" "$":{"id":"kw0110"} "$$":[{"#name":"text" "_":"Free Urinary Cortisol GCs"} {"#name":"keyword" "$":{"id":"kw0120"} "$$":[{"#name":"text" "_":"Glucocorticoids HIV"} {"#name":"keyword" "$":{"id":"kw0130"} "$$":[{"#name":"text" "_":"Human Immunodeficiency Virus IL-6"} {"#name":"keyword" "$":{"id":"kw0140"} "$$":[{"#name":"text" "_":"Interleukin-6 NPA"} {"#name":"keyword" "$":{"id":"kw0150"} "$$":[{"#name":"text" "_":"Nasopharyngeal Aspiration PCP"} {"#name":"keyword" "$":{"id":"kw0160"} "$$":[{"#name":"text" "_":"Pneumocystis Pneumonia TNFα"} {"#name":"keyword" "$":{"id":"kw0170"} "$$":[{"#name":"text" "_":"Tumor Necrosis Factor α TMP/SMX"} {"#name":"keyword" "$":{"id":"kw0180"} "$$":[{"#name":"text" "_":"Trimethoprim/Sulfamethoxazole ULN"} {"#name":"keyword" "$":{"id":"kw0190"} "$$":[{"#name":"text" "_":"Upper Limit Of Normal Range |
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