Multiple pulmonary nodules in ectopic adrenocorticotropic hormone syndrome: cause or result?
OBJECTIVE
To report a case of invasive pulmonary aspergillosis mimicking lung cancer with lung to lung metastases in ectopic adrenocorticotropic hormone syndrome (EAS).


METHODS
A 60-year-old man suffering from hypokalemic alkalosis, hypertension and limbs paralysis was referred to our hospital. EAS caused by malignancy of lung was highly suspected due to multiple pulmonary nodules presenting on chest film and positron emission tomography (PET) images. Video-assisted thoracic surgical biopsy tissue was used to confirm invasive aspergillosis instead of malignancy. Finally, the patient died of opportunistic infection.


CONCLUSIONS
This case showed that although EAS is usually associated with solid tumors, multiple pulmonary nodules secondary to opportunistic infections such as invasive aspergillosis must be kept in mind.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
Shan-Yueh
SY
Chang
Tzu-Chuan
TC
Huang
Wen-Lin
WL
Su
Chih-Feng
CF
Chian
Wann-Cherng
WC
Perng
D000182:ACTH Syndrome, Ectopic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000032:analysis; D000935:Antifungal Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy*; D008171:Lung Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis* / Q000473:pathology
D000935:Antifungal Agents; D000324:Adrenocorticotropic Hormone