Severe infection including disseminated herpes zoster triggered by subclinical Cushing's disease: a case report

• Published in: BMC endocrine disorders Vol. 21; no. 1; p. 84
• Main Authors: Yamauchi, Yuki, Kameda, Hiraku, Omori, Kazuno, Tani, Michio, Cho, Kyu Yong, Nakamura, Akinobu, Miyoshi, Hideaki, Tanaka, Shinya, Atsumi, Tatsuya
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.04.2021; BioMed Central; BMC
• Subjects: Abscesses; ACTH; Adenoma; Adrenocorticotropic hormone; Aging; Antibiotics; Autopsy; Blood; Cabergoline; Case Report; Case reports; Chicken pox; Cushing's disease; Diabetes; Disseminated herpes zoster; Fever; Health aspects; Herpes zoster; HIV; Hormones; Human immunodeficiency virus; Immunodeficiency; Immunosuppression; Immunotherapy; Infection; Infections; Insulin glargine; Kidney diseases; Laboratories; Liraglutide; Lymphocytes; Magnetic resonance imaging; Medical colleges; Medical research; Medicine, Experimental; Metabolism; Mortality; Nervous system diseases; Patients; Pituitary; Plasma; Pyelonephritis; Sepsis; Shingles (Disease); Subclinical Cushing’s disease; Type 2 diabetes; Infection; Disseminated herpes zoster; Subclinical Cushing’s disease
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-021-00757-y

Subclinical Cushing's disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing's disease. Infection is an important complication associated with mortality in Cushing's disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome. An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ. As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.