Case report: nocardia infection associated with ectopic cushings

Rizwan, Azra; Sarfaraz, Aqiba; Jabbar, Abdul; Akhter, Jaweed; Islam, Najmul

doi:10.1186/1472-6823-14-51

Cited by 8 publications

(7 citation statements)

References 10 publications

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“…It was noted that these radiologic findings could also be the presentation of fungal, mycobacterial infections, and malignancies including both primary and metastatic lung cancers. Lung nodules were suspected to be tumors of EAS in five patients (27.7%) ( 19 , 21 – 23 ) in our series including our patient. Biopsies of suspicious lung nodules were performed.…”

Section: Discussionmentioning

confidence: 54%

Cushing’s Syndrome With Nocardiosis: A Case Report and a Systematic Review of the Literature

et al. 2021

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ObjectiveTo analyze and summarize the clinical characteristics, treatments, and prognosis of Cushing’s syndrome (CS) with nocardiosis.MethodsA patient in our hospital and additional 17 patients of CS with nocardiosis in the English literature were included in this study. Clinical characteristics, laboratory data, imaging studies, treatments, and prognosis were evaluated.ResultsA 41-year-old man with CS was diagnosed and treated in our hospital. He had co-infections of nocardiosis and aspergillosis. Together with 17 patients of CS with nocardiosis in the English literature, 2 patients (11.1%) were diagnosed as Cushing’s disease (CD) while 16 (88.9%) were diagnosed or suspected as ectopic ACTH syndrome (EAS). The average 24hrUFC was 7,587.1 ± 2,772.0 μg/d. The average serum total cortisol and ACTH (8 AM) was 80.2 ± 18.7 μg/dl and 441.8 ± 131.8 pg/ml, respectively. The most common pulmonary radiologic findings in CT scan were cavitary lesions (10/18) and nodules (8/18). Co-infections were found in 33.3% (6/18) patients. The CS patients with co-infections had higher levels of ACTH (671.5 ± 398.2 vs 245.5 ± 217.1 pg/ml, P = 0.047), and 38.9% (7/18) patients survived through the antibiotic therapy and the treatment of CS. Patients with lower level of ACTH (survival vs mortality: 213.1 ± 159.0 vs 554.7 ± 401.0 pg/ml, P = 0.04), no co-infection, underwent CS surgery, and received antibiotic therapy for more than 6 months, had more possibilities to survive.ConclusionsNocardia infection should be cautioned when a patient of CS presented with abnormal chest radiographs. The mortality risk factors for CS with nocardiosis are high level of ACTH and co-infections. We should endeavor to make early etiological diagnosis, apply long-term sensitive antibiotics and aggressive treatments of CS.

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Section: Discussionmentioning

confidence: 54%

Cushing’s Syndrome With Nocardiosis: A Case Report and a Systematic Review of the Literature

et al. 2021

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“…In addition, the references in the articles that referred to nocardiosis and ectopic ACTH syndrome were also examined. A total of 9 articles with full-text describing 11 cases were available (5–14). Including the present case, the clinical characteristics of EAS with Nocardia infection in 12 cases were analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the clinical features of 11 published cases of EAS associated with Nocardia infection were analyzed (5–11). The aim of this study was to provide guidance for the clinical diagnosis and treatment of Nocardia infection associated with EAS.…”

Section: Introductionmentioning

confidence: 99%

Nocardiosis in ectopic ACTH syndrome: A case report and review of 11 cases from the literature

Yang

et al. 2016

Experimental and Therapeutic Medicine

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Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) associated with nocardiosis is rare, and little information is available regarding its clinical characteristics. In this study, the case of a 35-year-old male patient who showed significant cushingoid features and had a cough with yellow phlegm for 1 month is described. Pulmonary computed tomography (CT) scanning and 18F-fluorodeoxyglucose positron emission tomography combined with CT identified two different lesions in the mediastinum and pulmonary region, respectively. The lesion in the mediastinum was finally diagnosed as an ACTH-secreting mediastinal paraganglioma via biopsy. The sputum culture confirmed pulmonary nocardiosis. The patient was effectively treated with complete tumor resection following the treatment of nocardiosis using trimethoprim-sulfamethoxazole. Following the present case, 11 additional cases of nocardiosis in EAS were identified in the literature and their clinical characteristics were compared and evaluated. It may be concluded that, although Nocardia remains a rare opportunistic infection pathogen in EAS, it is necessary to consider nocardiosis as a diagnosis for patients with pulmonary imaging findings of cavity, consolidation or nodule, particularly when there are brain and extra-pulmonary lesions as well as a poor response to regular treatment.

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“…88,89,92 Because of the masking eff ect caused by the anti-infl ammatory action of glucocorticoids, total leucocyte counts or temperature are not reliable indicators of active infection, and the absolute concentration of cortisol is the best predictor of severe infection in patients with Cushing's syndrome. 89 The increased risk of infection associated with severe cortisol excess applies to virtually any microbial pathogen, 86,93 but some infections are more common 94 Fungal infections are also frequent, with the most typical fungal pathogens being Candida spp, Aspergillus spp, and Cryptococcus spp as well as Pneumocystis jirovecii. 86,93 Invasive fungal infections should be suspected in patients with Cushing's syndrome with early signs and symptoms of infection that are unresponsive to broad-spectrum antibiotics.…”

Section: Infectious Diseasesmentioning

confidence: 99%

Complications of Cushing's syndrome: state of the art

Pivonello

Isidori

Martino

et al. 2016

The Lancet Diabetes & Endocrinology

455

439

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Cushing's syndrome is a serious endocrine disease caused by chronic, autonomous, and excessive secretion of cortisol. The syndrome is associated with increased mortality and impaired quality of life because of the occurrence of comorbidities. These clinical complications include metabolic syndrome, consisting of systemic arterial hypertension, visceral obesity, impairment of glucose metabolism, and dyslipidaemia; musculoskeletal disorders, such as myopathy, osteoporosis, and skeletal fractures; neuropsychiatric disorders, such as impairment of cognitive function, depression, or mania; impairment of reproductive and sexual function; and dermatological manifestations, mainly represented by acne, hirsutism, and alopecia. Hypertension in patients with Cushing's syndrome has a multifactorial pathogenesis and contributes to the increased risk for myocardial infarction, cardiac failure, or stroke, which are the most common causes of death; risks of these outcomes are exacerbated by a prothrombotic diathesis and hypokalaemia. Neuropsychiatric disorders can be responsible for suicide. Immune disorders are common; immunosuppression during active disease causes susceptibility to infections, possibly complicated by sepsis, an important cause of death, whereas immune rebound after disease remission can exacerbate underlying autoimmune diseases. Prompt treatment of cortisol excess and specific treatments of comorbidities are crucial to prevent serious clinical complications and reduce the mortality associated with Cushing's syndrome.

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Case report: nocardia infection associated with ectopic cushings

Cited by 8 publications

References 10 publications

Cushing’s Syndrome With Nocardiosis: A Case Report and a Systematic Review of the Literature

Cushing’s Syndrome With Nocardiosis: A Case Report and a Systematic Review of the Literature

Nocardiosis in ectopic ACTH syndrome: A case report and review of 11 cases from the literature

Complications of Cushing's syndrome: state of the art

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