title: Fatal factitious Cushing's syndrome and invasive aspergillosis: case report and review of literature.
abstract: OBJECTIVE
  To present the first reported fatality from invasive aspergillosis related to factitious Cushing's syndrome.
  
  
  METHODS
  We summarize the history, clinical findings, and outcome in a patient ultimately found to have factitious Cushing's syndrome. In addition, the dangers of fulminant infections in untreated Cushing's syndrome are analyzed relative to molecular and immunologic aspects, and the pertinent literature is reviewed.
  
  
  RESULTS
  A 33-year-old female medical transcriptionist was admitted with rapidly fatal septic shock and diffuse pulmonary infiltrates. Autopsy revealed invasive pulmonary aspergillosis and atrophied adrenal cortices. On subsequent investigation, hidden bottles of prednisone were found throughout the patient's home. Factitious Cushing's syndrome has rarely been described and can be a difficult diagnosis to establish, but it is important to recognize this condition because of its potentially drastic consequences. Our understanding of the mechanism of immunosuppression from glucocorticoids related to the increased risk of invasive fungal infections is evolving. Factitious illness can manifest in numerous ways; therefore, health-care providers in all specialties should be familiar with epidemiologic, diagnostic, and treatment considerations for this illness.
  
  
  CONCLUSIONS
  Endocrinologists should be aware of the possibility of factitious Cushing's syndrome because it can be an elusive and ultimately fatal condition.
authors.affiliation: Department of Internal Medicine, Portland VA Medical Center/Oregon Health and Sciences University, Portland, Oregon 97239, USA.
authors.forename: Devan L
authors.initials: DL
authors.lastname: Kansagara
authors.forename: Jeanette
authors.initials: J
authors.lastname: Tetrault
authors.forename: Chalmers
authors.initials: C
authors.lastname: Hamill
authors.forename: Caleb
authors.initials: C
authors.lastname: Moore
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olson
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000209:etiology*; D003480:Cushing Syndrome / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis*; D005162:Factitious Disorders / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis*; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000506:poisoning; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications; D011241:Prednisone / Q000506:poisoning
chemical_list: D005938:Glucocorticoids; D011241:Prednisone