2 cases of Pneumocystis Jirovecii Pneumonia occurring during treatment of Cushing's Syndrome. Is there a case for prophylaxis of PJP in the treatment of severe hypercortisolism?

Amy Hunter, Steven Hunter, David McCance, Joseph Walsh
2018 Endocrine Abstracts  
A 30 year old man with no past medical history presented with bloody diarrhoea, abdominal pain, lethargy, facial swelling, weight gain, shortness of breath, leg weakness and mood disturbance. On examination he was cushingoid with fresh striae, thin bruised skin, proximal myopathy and bilateral pitting oedema. There was bilateral knee swelling with moderate effusions and oral candidiasis. Visual fields were intact to confrontation. He was hypertensive and hyperglycaemic (20.1 mmol/mol). He was
more » ... mmol/mol). He was admitted to the regional endocrinology unit for investigation. Advice was sought from Infectious Diseases and he was treated with cotrimoxazole, quadruple TB therapy and ganciclovir. Progress was slow and after a life threatening illness in ICU he was discharged to the ward for metyrapone titration and 1 week of further haemodialysis. The risk of further infection was considered too great to stop metyrapone for petrosal sinus sampling. Following a CT chest, abdomen and pelvis and an octreotide scan to exclude an ectopic source of ACTH, it was concluded that the diagnosis was that of Cushing's Disease. At trans sphenoidal surgery, an ACTH positive pituitary adenoma was resected and following radiotherapy he is now in remission and no longer requires PJP prophylaxis.
doi:10.1530/endoabs.59.ep42 fatcat:ivr7pkidbjf7diorutxqafb4eu