Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Internal Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-8503, Japan.
Department of Internal Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-8503, Japan.
J Infect Chemother. 2020 Dec;26(12):1301-1304. doi: 10.1016/j.jiac.2020.07.008. Epub 2020 Jul 31.
Corticosteroids have been used for the treatment of a great variety of diseases. Therefore, the relationship between high doses of cortisol and infections has been widely known and prophylactic therapy has been established. Adrenocortical carcinoma is a rare malignancy with poor prognosis, so little is known about how to deal with the complications resulting from hormone excess such as Cushing's syndrome. Here we report a case of an 82-year-old woman who presented with a 1-day history of dyspnea and was finally diagnosed as disseminated cryptococcosis at autopsy. The patient had received a diagnosis of metastatic adrenocortical carcinoma and Cushing's syndrome three months earlier. The findings of this study indicate the relation between severe hypercortisolemia due to adrenocortical carcinoma and opportunistic infections. In the setting of adrenocortical carcinoma with Cushing's syndrome, clinicians should maintain a high index of suspicion for opportunistic infections including cryptococcosis, which are potentially treatable by early detection and prompt intervention.
皮质类固醇已被广泛用于治疗各种疾病。因此，人们已经广泛了解到高剂量皮质醇与感染之间的关系，并建立了预防性治疗。肾上腺皮质癌是一种预后不良的罕见恶性肿瘤，因此对于如何处理皮质醇过多引起的并发症（如库欣综合征）知之甚少。在这里，我们报告了一例 82 岁女性患者，因呼吸困难就诊，最终在尸检时被诊断为播散性隐球菌病。该患者在三个月前被诊断为转移性肾上腺皮质癌和库欣综合征。本研究结果表明，严重的高皮质醇血症与机会性感染之间存在关联。在伴有库欣综合征的肾上腺皮质癌患者中，临床医生应保持高度警惕，注意包括隐球菌病在内的机会性感染，这些感染通过早期发现和及时干预是可以治疗的。
