title: Pneumocystis pneumonia during medicamentous treatment of Cushing's syndrome--a description of two cases.
abstract: Only a few cases of pneumocystis pneumonia (PCP) in Cushing's syndrome have been published in the literature so far. In the majority of these patients, the pneumonia occurred after reduction of the hypercortisolism with medicamentous treatment. We report two cases of PCP during conservative treatment of hypercortisolism. We describe clinical, imaging and laboratory findings in two patients and review published cases of pneumocystits pneumonia in Cushing's syndrome. A 60-year-old woman and 20-year-old man with Cushing's syndrome due to ectopic ACTH syndrome were treated at our department. Both developed pneumocystis pneumonia early after treatment with ketoconazole and ethomidate bromide had been introduced and the levels of cortisol rapidly decreased. PCP prophylaxis in patients with high cortisolemia should be started before treatment of hypercortisolism in current practice. Gradual lowering of plasma cortisol should also reduce the risk of infection by Pneumocystis jiroveci.
authors.affiliation: Second Department of Internal Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic. gabalec@fnhk.cz
authors.forename: Filip
authors.initials: F
authors.lastname: Gabalec
authors.forename: Alzbeta
authors.initials: A
authors.lastname: Zavrelová
authors.forename: Eduard
authors.initials: E
authors.lastname: Havel
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Cerman
authors.forename: Jakub
authors.initials: J
authors.lastname: Radocha
authors.forename: Ioannis
authors.initials: I
authors.lastname: Svilias
authors.forename: Jan
authors.initials: J
authors.lastname: Cáp
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000097:blood / Q000188:drug therapy*; D005045:Etomidate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology; D011020:Pneumonia, Pneumocystis / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D007654:Ketoconazole; D006854:Hydrocortisone; D005045:Etomidate