title: Life-threatening Pneumocystis jiroveci pneumonia following treatment of severe Cushing's syndrome.
abstract: We describe two patients with a severe Cushing's syndrome due to ectopic production of ACTH. Both patients developed a life-threatening Pneumocystis jiroveci pneumonia (PCP) shortly after treatment of the hypercortisolism was started by means of inhibition of production of glucocorticoids and glucocorticoid receptor blockade. We presume that the restored immune response elicited the clinical symptoms of the opportunistic, previously subclinical Pneumocystis jiroveci infection. The immunocompromised state and the delicate glucocorticoid balance in patients with a severe Cushing's syndrome necessitate a specific diagnostic and therapeutic approach.
authors.affiliation: Department of Anaesthesiology, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands.
authors.forename: J K
authors.initials: JK
authors.lastname: Oosterhuis
authors.forename: G
authors.initials: G
authors.lastname: van den Berg
authors.forename: W E
authors.initials: WE
authors.lastname: Monteban-Kooistra
authors.forename: J J M
authors.initials: JJ
authors.lastname: Ligtenberg
authors.forename: J E
authors.initials: JE
authors.lastname: Tulleken
authors.forename: J H J M
authors.initials: JH
authors.lastname: Meertens
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D003480:Cushing Syndrome / Q000150:complications*; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008875:Middle Aged; D015735:Mifepristone / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000209:etiology; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012307:Risk Factors; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D013148:Spironolactone; D015735:Mifepristone; D007654:Ketoconazole