Case Report—Secondary Antibody Deficiency Due to Endogenous Hypercortisolism

Sarcevic, Jelena; Cavelti-Weder, Claudia; Berger, Christoph; Trendelenburg, Marten

doi:10.3389/fimmu.2020.01435

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Concomitant splenectomy may influence the patients’ immune capacity. Additionally, the patients may suffer from hypogammaglobulinemia, which is caused by endogenous or therapeutic hypercortisolism and leads to a decreased immunoglobulin G (IgG) production and increased IgG catabolism [ 9 , 10 ]. The low level of IgG may persist even after discontinuation of steroid treatment [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Refractory postoperative Staphylococcus hominis bacteremia in a patient with an ACTH-producing pancreatic neuroendocrine neoplasm: a case report

et al. 2022

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Background Staphylococcus hominis (S. hominis) is an opportunistic pathogen that is often highly resistant to antibiotics and is difficult to treat. In patients diagnosed with an adrenocorticotropic hormone (ACTH)-producing tumor that compromises the immune system due to hypercortisolemia, cancer treatment and infection control should be considered simultaneously. This report presents a case of refractory postoperative S. hominis bacteremia requiring the prolonged administration of several antibiotics in a patient with an ACTH-producing pancreatic neuroendocrine neoplasm (pNEN). Case presentation A 35-year-old man visited a neighboring hospital for a thorough examination after experiencing weight gain and lower limb weakness for several months. Enhanced computed tomography revealed a pancreatic tail tumor and bilateral adrenal enlargement. Elevated plasma ACTH and serum cortisol were noted. Biopsy under endoscopic ultrasonography revealed the tumor as an ACTH-producing pNEN. The patient was transferred to our hospital for further treatment. Pneumocystis pneumonia was noted and treated with sulfamethoxazole and adjunctive glucocorticoids. Hypercortisolism was controlled with metyrapone and trilostane. Somatostatin receptor scintigraphy and ethoxybenzyl magnetic resonance imaging detected other lesions in the pancreatic head. A total pancreatectomy was performed given that the lesions were found in both the pancreatic head and tail. Plasma ACTH and serum cortisol levels decreased immediately after the resection. Pathological examination revealed that the pancreatic tail tumor was NEN G2 and T3N1aM0 Stage IIB and the pancreatic head lesions were SSTR-positive hyperplasia of the islet of Langerhans cells. On postoperative day 11, catheter-associated bacteremia occurred. Initially, meropenem hydrate and vancomycin hydrochloride were administered empirically. S. hominis was identified and appeared sensitive to these antibiotics according to susceptibility testing. However, S. hominis was repeatedly positive in blood cultures for more than one month, despite treatment with several antibiotics. Eventually, with the combined use of three antibiotics (meropenem hydrate, vancomycin hydrochloride, and clindamycin phosphate) for more than 3 weeks, the S. hominis-associated bacteremia improved. He was discharged 79 days after surgery. Conclusions Our patient with an ACTH-producing pNEN was immunocompromised and needed meticulous attention for infectious complications even after successful tumor removal. Specifically, S. hominis bacteremia in such patients demands intensive treatments, such as with combinational antibiotics.

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Section: Discussionmentioning

confidence: 99%

Refractory postoperative Staphylococcus hominis bacteremia in a patient with an ACTH-producing pancreatic neuroendocrine neoplasm: a case report

et al. 2022

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“…The critical role of hypothalamic-pituitaryadrenal axis dysregulation and altered cortisol secretion in the manifestation of MDD is well established (Krishnan and Nestler, 2008). Physiological states associated with high levels of circulating cortisol, such as hypercortisolism (Sarcevic et al, 2020) or treatment of patients with corticosteroid-based interventions, shifts serum antibody profiles relative to healthy controls (Griggs et al, 1972;Settipane et al, 1978). As well, neuronal surface autoantibody expression has been implicated in a number of neuropsychiatric conditions, MDD included (Zong et al, 2017).…”

Section: Evidence Of Immune Impacts On the Development And Persistenc...mentioning

confidence: 99%

Estrogen, the Peripheral Immune System and Major Depression – A Reproductive Lifespan Perspective

Engler-Chiurazzi

Chastain

Citron

et al. 2022

Front. Behav. Neurosci.

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Major depression is a significant medical issue impacting millions of individuals worldwide. Identifying factors contributing to its manifestation has been a subject of intense investigation for decades and several targets have emerged including sex hormones and the immune system. Indeed, an extensive body of literature has demonstrated that sex hormones play a critical role in modulating brain function and impacting mental health, especially among female organisms. Emerging findings also indicate an inflammatory etiology of major depression, revealing new opportunities to supplement, or even supersede, currently available pharmacological interventions in some patient populations. Given the established sex differences in immunity and the profound impact of fluctuations of sex hormone levels on the immune system within the female, interrogating how the endocrine, nervous, and immune systems converge to impact women’s mental health is warranted. Here, we review the impacts of endogenous estrogens as well as exogenously administered estrogen-containing therapies on affect and immunity and discuss these observations in the context of distinct reproductive milestones across the female lifespan. A theoretical framework and important considerations for additional study in regards to mental health and major depression are provided.

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Corticosteroid-induced low immunoglobulin levels in multiple sclerosis — A confounding factor

Bonnan,

Courtade,

Debeugny

2023

Multiple Sclerosis and Related Disorders

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Case Report—Secondary Antibody Deficiency Due to Endogenous Hypercortisolism

Cited by 3 publications

References 8 publications

Refractory postoperative Staphylococcus hominis bacteremia in a patient with an ACTH-producing pancreatic neuroendocrine neoplasm: a case report

Refractory postoperative Staphylococcus hominis bacteremia in a patient with an ACTH-producing pancreatic neuroendocrine neoplasm: a case report

Estrogen, the Peripheral Immune System and Major Depression – A Reproductive Lifespan Perspective

Corticosteroid-induced low immunoglobulin levels in multiple sclerosis — A confounding factor

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