Fatal Aspergillus fumigatus septicemia in a patient with an ectopic ACTH-producing neuroendocrine pancreatic tumor

The case of a 71-yr-old Caucasian patient who suffered from an adrenocortic otropic hormone (ACTH)-producing tumor and developed a fulminant Aspergillu s fumigatus septicemia is reported. The patient presented initially with a recent onset of hyperglycemia and had excessive plasma levels of cortisol a nd ACTH. A computer-assisted tomography scan showed a tumor associated with in the head of the pancreas. During his hospital course, he developed a rap id progressive fatal Aspergillus fumigatus pneumonia and an upper gastroint estinal bleeding. At necropsy multiple abscesses in the brain, lungs, heart , kidneys, small bowel and mesentery were present as a result of Aspergillu s septicemia. A neuroendocrine pancreatic tumor, 8 cm in diameter, was foun d in the head of the pancreas without any signs of malignancy. The tumor sh owed immunohistochemical and electron microscopic evidence of ACTH expressi on, but of no other pituitary or pancreatic hormones. This case demonstrate s the fulminant progress of a septicemia based on an immunologically compro mised patient because of ectopic Gushing's syndrome. Early diagnosis of ect opic ACTH syndromes is essential for adequate therapy in order to prevent c omplications and fatal infections.