Overwhelming Opportunistic Infections as the Initial Presentation of Severe Cushing Syndrome
https://doi.org/10.15605/jafes.041.S1
- Author:
Kirtthene Gopal
1
;
Ooi Chuan Ng
2
;
Yee Lin Lee
2
Author Information
1. Hospital Sultan Abdul Aziz Shah; Universiti Putra Malaysia
2. Universiti Putra Malaysia
- Publication Type:Journal Article
- MeSH:
Cushing Syndrome;
Opportunistic Infections
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):28-29
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypercortisolism is associated with profound
impairment of both innate and adaptive immune responses,
predisposing affected individuals to opportunistic infections. Excess glucocorticoids alter leukocyte trafficking,
suppress pro-inflammatory cytokine production, and
impair cellular immunity, increasing susceptibility to
bacterial, viral, and fungal pathogens. In some cases, severe
infections may precede the diagnosis of Cushing syndrome
and represent the initial clinical manifestation. Early
recognition is important as untreated hypercortisolism can
lead to substantial morbidity and mortality.
Case:A young adolescent male presented with progressive
facial fullness and facial hyperpigmentation for 4 months,
followed by 1 month of intermittent fever, cough, lower
limb weakness, and hallucinations. On examination, he
was tachypneic with cushingoid features including moon
facies, pigmented acne over the face and chest, and nail bed
hyperpigmentation. He was hypertensive and had severe
hypokalemia with lymphopenia. Radiological imaging demonstrated multiple cavitary lung
lesions and intracranial tuberculomas. Bronchoalveolar
lavage identified multiple opportunistic pathogens,
including Pneumocystis jirovecii, Aspergillus fumigatus, and
Haemophilus influenzae, while cerebrospinal fluid testing
was positive for cytomegalovirus.
Given the unusual combination of infections, an underlying
immunocompromised state was suspected. Endocrine
evaluation revealed markedly elevated serum cortisol, with
loss of diurnal rhythm and elevated adrenocorticotropic
hormone (ACTH). Twenty-four-hour urinary cortisol
was significantly increased, confirming severe ACTHdependent Cushing syndrome. Magnetic resonance
imaging of the pituitary gland and computed tomography
imaging of the thorax, abdomen, and pelvis did not identify
the source of ACTH secretion.
Conclusion:This case highlights that overwhelming opportunistic
infections may be the first manifestation of severe
Cushing syndrome in children. Excess cortisol disrupts
host defenses by impairing neutrophil chemotaxis and
macrophage phagocytosis, suppressing T-cell-mediated
immunity, and reducing cytokine signaling necessary
for pathogen clearance. These mechanisms contribute to
susceptibility to simultaneous bacterial, fungal, and viral
infections. Clinicians should therefore consider underlying
hypercortisolism in patients presenting with multiple or
unusual opportunistic infections to enable earlier diagnosis
and appropriate multidisciplinary management.
- Full text:2026072814033350969EP_A019.pdf
