Cushing's syndrome and nocardiosis associated with a pulmonary carcinoid tumor: Report of a case and review of the literature

Sutton, Brian J.; Parks, Graham; Manavi, Cyrus; Palavecino, Elizabeth; Geisinger, Kim R.

doi:10.1002/dc.21428

Cited by 14 publications

(7 citation statements)

References 10 publications

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“…Gram staining demonstrated gram positive branching organisms, and specimen culture grew Nocardia spp. [3]. Their case was amongst the first reporting use of the fine needle aspiration technique to diagnose both the pulmonary tumour, as well as the associated infectious complication arising from the hypercortisolism resulting from the tumour [3].…”

Section: Discussionmentioning

confidence: 99%

“…[3]. Their case was amongst the first reporting use of the fine needle aspiration technique to diagnose both the pulmonary tumour, as well as the associated infectious complication arising from the hypercortisolism resulting from the tumour [3]. Boscaro M et al report a patient with a disseminated form of nocardiosis in the setting of hypercortisolism resulting from bilateral nodular hyperplasia [11].…”

Section: Discussionmentioning

confidence: 99%

“…This sets the stage for the occurrence of bacterial and fungal opportunistic infections [2]. Nocardiosis is a gram positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia [3]. …”

Section: Introductionmentioning

confidence: 99%

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Case report: nocardia infection associated with ectopic cushings

et al. 2014

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BackgroundCushing’s syndrome results from exposure to excess glucocorticoids. Ectopic Cushings is endogenous ACTH dependant form of Cushing’s associated with markedly raised ACTH and cortisol levels. This leads to an impaired immune response, setting the stage for occurrence of opportunistic infections. Nocardiosis is a gram positive bacterial infection caused by aerobic actinomycetes in genus Nocardia. We report a series of patients diagnosed with ectopic Cushings, having pneumonia with Nocardia spp. In one of these cases, the manifestations of Cushing’s disappeared with treatment for Nocardia.Case presentationTwo middle aged men of Asian descent presented to the Endocrine clinic: the first with history of exertional shortness of breath, and weight loss for 1 year, the other with facial swelling, disturbed sleep and lethargy for a month. The third case was a young Asian male who presented with progressive weakness & weight loss for 2 months. All three patients had uncontrolled hypertension, high blood sugars & were hypokalemic (K: 2.52, 2.9, 1.5 mmol/l); 24 hour urine cortisol was elevated at 2000, 27216 and 9088 (32-243 ug/24 hours); ACTH 68.5, 159, 255 [0–48 pg/ml), respectively. Their MRI pituitary was normal, inferior petrosal sinus sampling revealed no central peripheral gradient. CT chest of these subjects demonstrated cavitatory lung lesions; microscopic analysis of respiratory samples was suggestive of infection with Nocardia spp. Histopathology of bronchoscopic-guided biopsy revealed no malignancy. Antihypertensives, insulin, potassium replacement, ketoconazole & trimethoprim-sulphamethoxazole (TS) were initiated. The patients’ symptomatology improved & cavitatory lesions resolved with treatment. The primary source for the ectopic cushings remained unknown. The first case required bilateral adrenalectomy. The second case followed a progressively downhill course leading to death. In the third case, we were able to completely taper off ketoconazole, potassium, insulin & antihypertensives, after starting TS.ConclusionOpportunistic infections are known to be associated with Cushing’s syndrome, and higher levels of glucocorticoid secretion are found in patients with ectopically produced ACTH. Pulmonary nocardiosis is important differential to consider. This series includes the first case reported in which signs and symptoms of cushings subsided after treatment of Nocardia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case report: nocardia infection associated with ectopic cushings

et al. 2014

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“…Third, multiple pulmonary nodules with sharply demarcated borders are often metastases, whereas primary lung cancer with lung metastases are often quite irregular [5]. Equally, invasive fungal infections are common in patients with ectopic ACTH production, probably due to the hypercortisol level causing impairment to cell-mediated immunity [6]. Although the typical finding of CT halo sign was not seen in our case, multiple areas of consolidation or small nodules could be due to invasive aspergillosis [7].…”

Section: Discussionmentioning

confidence: 99%

Multiple Pulmonary Nodules in Ectopic Adrenocorticotropic Hormone Syndrome: Cause or Result?

Chang

Huang²,

Su³

et al. 2012

Med Princ Pract

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Objective: To report a case of invasive pulmonary aspergillosis mimicking lung cancer with lung to lung metastases in ectopic adrenocorticotropic hormone syndrome (EAS). Clinical Presentation and Intervention: 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. Conclusion: 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.

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“…A Gram stain revealed numerous Gram-positive branching organisms, and culture of the specimen grew Nocardia asteroides. Her pulmonary infection was treated with antibiotics and she underwent successful ablation of the carcinoid tumor [12].…”

Section: Hypercortisolemia and Infectionmentioning

confidence: 99%

Cushing Syndrome due to Ectopic ACTH Secretion Presenting With Lower Limb Edema and Pulmonary Nocardia Infection: Case Report and Review of the Literature

2016

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Ectopic ACTH secretion has been described since 1962, but its presentation as only lower limbs edema was rarely described. Symptoms and signs are very similar to Cushing disease, but with a more rapid onset and progression of symptoms. Cushing syndrome presenting as lower limbs edema only has been reported once. We present here a case of a 60-year-old male patient with ectopic ACTH secretion presenting with isolated lower limb edema and developing pulmonary nocardia infection.

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Cushing's syndrome and nocardiosis associated with a pulmonary carcinoid tumor: Report of a case and review of the literature

Cited by 14 publications

References 10 publications

Case report: nocardia infection associated with ectopic cushings

Case report: nocardia infection associated with ectopic cushings

Multiple Pulmonary Nodules in Ectopic Adrenocorticotropic Hormone Syndrome: Cause or Result?

Cushing Syndrome due to Ectopic ACTH Secretion Presenting With Lower Limb Edema and Pulmonary Nocardia Infection: Case Report and Review of the Literature

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