Gabalec Filip, Zavrelová Alzbeta, Havel Eduard, Cerman Jaroslav, Radocha Jakub, Svilias Ioannis, Cáp Jan
Second Department of Internal Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic.
Acta Medica (Hradec Kralove). 2011;54(3):127-30. doi: 10.14712/18059694.2016.35.
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.
迄今为止，文献中仅发表了少数几例库欣综合征合并肺孢子菌肺炎（PCP）的病例。在这些患者中，大多数肺炎是在通过药物治疗降低高皮质醇血症后发生的。我们报告了两例在高皮质醇血症保守治疗期间发生的PCP病例。我们描述了两名患者的临床、影像学和实验室检查结果，并回顾了已发表的库欣综合征合并肺孢子菌肺炎的病例。一名60岁女性和一名20岁男性因异位促肾上腺皮质激素（ACTH）综合征导致库欣综合征，在我们科室接受治疗。两人在开始使用酮康唑和依托咪酯溴化物治疗且皮质醇水平迅速下降后不久均发生了肺孢子菌肺炎。在当前实践中，对于高皮质醇血症患者，应在治疗高皮质醇血症之前开始预防PCP。逐渐降低血浆皮质醇水平也应降低耶氏肺孢子菌感染的风险。
