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Pneumocystis carinii Pneumonia Associated With Solid Ectopic Corticotropin-Producing Tumors

Daniel P. McQuillen, MD; Alan M. Sugar, MD
Arch Neurol. 1992;49(10):1012-1012. doi:10.1001/archneur.1992.00530340028012
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To the Editor.  —We read with interest the review of cases of Pneumocystis carinii pneumonia (PCP) occurring in patients with primary brain tumors who were treated with long-term dexamethasone therapy.1 In their discussion, Henson et al1 note the well-documented association of PCP with the use of high-dose corticosteroids and the appearance of clinical pneumonia as steroid doses are tapered. The authors state that reports of PCP among patients with solid tumors are rare and suggest that PCP may occur in a subset of patients with solid tumors, namely, those with brain tumors. They conclude that PCP in these patients is due to the use of high-dose corticosteroids.It is important to note that patients with solid ectopic corticotropin-producing tumors are also at risk for the development of PCP (and other opportunistic infections). Graham and Tucker2 reviewed 23 cases of opportunistic infections (cryptococcosis, aspergillosis, nocardiosis, and PCP) in

REFERENCES

Henson JW, Jalaj JK, Walker RW, Stover DE, Fels AOS.  Pneumocystis carinii pneumonia in patients with primary brain tumors . Arch Neurol . 1991;;48:406-409.
Graham BS, Tucker WS.  Opportunistic infections in endogenous Cushing's syndrome . Ann Intern Med . 1984;;101:334-338.
Farrant PC, Insley J.  Increased adrenocortical activity and malignant disease . Lancet . 1950;;2:434.
Sayle BA, Lang PA, Green WO, et al.  Cushing's syndrome due to islet cell carcinoma of the pancreas: report of two cases, one with elevated 5-hydroxyindole acetic acid and complicated by aspergillosis . Ann Intern Med . 1965;;63:58-68.
Higgins TL, Calabrese LH, Sheeler LR.  Opportunistic infections in patients with ectopic ACTH-secreting tumors . Cleve Clin Q . 1982;;49:43-49.
McQuillen DP, Schroy PC, Hesketh PJ, Sugar AM.  Pneumocystis carinii pneumonia complicating somatostatin therapy of Cushing's syndrome in a patient with metastatic pancreatic islet cell carcinoma and Zollinger-Ellison syndrome . Am J Gastroenterol . 1991;;86:512-514.
Sieber SC, Dandurand R, Gelfman N, lannini P, Braza F.  Three opportunistic infections associated with ectopic corticotropin syndrome . Arch Intern Med . 1989;;149:2589-2591.

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Henson JW, Jalaj JK, Walker RW, Stover DE, Fels AOS.  Pneumocystis carinii pneumonia in patients with primary brain tumors . Arch Neurol . 1991;;48:406-409.
Graham BS, Tucker WS.  Opportunistic infections in endogenous Cushing's syndrome . Ann Intern Med . 1984;;101:334-338.
Farrant PC, Insley J.  Increased adrenocortical activity and malignant disease . Lancet . 1950;;2:434.
Sayle BA, Lang PA, Green WO, et al.  Cushing's syndrome due to islet cell carcinoma of the pancreas: report of two cases, one with elevated 5-hydroxyindole acetic acid and complicated by aspergillosis . Ann Intern Med . 1965;;63:58-68.
Higgins TL, Calabrese LH, Sheeler LR.  Opportunistic infections in patients with ectopic ACTH-secreting tumors . Cleve Clin Q . 1982;;49:43-49.
McQuillen DP, Schroy PC, Hesketh PJ, Sugar AM.  Pneumocystis carinii pneumonia complicating somatostatin therapy of Cushing's syndrome in a patient with metastatic pancreatic islet cell carcinoma and Zollinger-Ellison syndrome . Am J Gastroenterol . 1991;;86:512-514.
Sieber SC, Dandurand R, Gelfman N, lannini P, Braza F.  Three opportunistic infections associated with ectopic corticotropin syndrome . Arch Intern Med . 1989;;149:2589-2591.

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