Pneumocystis pneumonia can complicate medical treatment of hypercortisolism even in outpatients with Cushing's disease.

摘要: Abstract Several cases of Pneumocystosis pneumonia (PCP) have been reported in patients with hypercortisolism, mainly severe ectopic ACTH syndrome (EAS). We report 2 cases PCP that did not develop until after starting treatment metyrapone, one which occurred an outpatient Cushing's disease (CD) without pulmonary symptoms before medical for CD. Patient 1 presented as CD and hypercortisolism but nonetheless good general condition. Treatment metyrapone was started pituitary surgery. Patient 2 had EAS due to prostate cancer. Respiratory failure the two 4 days 30 days, respectively, start treatment. In both cases, chest CT showed bilateral interstitial infiltrates, Pneumocystis jirovecii found on bronchoalveolar lavage (BAL). A literature review performed identify risk factors CD: we identified 20 other treated including 16 patients EAS. Ninety percent free urinary cortisol greater than 6 times upper limit normal (ULN). conclusion, onset initiation anticortisolic therapy is limited EAS, may occur elevated levels, even if patient remains condition has no such patients, routine prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) should be considered.