International Journal of Gerontology
Volume 3, Issue 1 , Pages 81-84, March 2009

Refractory Post-Herpetic Neuralgia As An Initial Presentation Of Olfactory Neuroblastoma-Related Ectopic ACTH Syndrome

  • Hsiang-Hung Lin

      Affiliations

    • Department of Internal Medicine, Mackay Memorial Hospital, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Chih-Ming Lin

      Affiliations

    • Department of Neurology, Mackay Memorial Hospital, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Hsiang-Kuang Tseng

      Affiliations

    • Department of Internal Medicine, Mackay Memorial Hospital, National Yang-Ming University, Taipei, Taiwan
    • Section of Infectious Disease, Mackay Memorial Hospital, National Yang-Ming University, Taipei, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Hsiang-Kuang Tseng, Department of Internal Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan

Accepted 4 February 2009.

Article Outline

SUMMARY 

We report a woman aged 64 years with ectopic adrenocorticotropic hormone (ACTH) syndrome caused by olfactory neuroblastoma as an initial presentation of refractory post-herpetic neuralgia. The manifestations such as cushingoid appearance and endocrine abnormalities are compatible with Cushing's syndrome. Brain computed tomography revealed a sellar mass. A biopsy revealed olfactory neuroblastoma. Immunohistochemical staining further defined the tumor as an ACTH-secreting neuroblastoma. Subsequent opportunistic infections by Candida glabrata fungemia and multiple drug-resistant Acinetobacter baumannii pneumonia occurred during hospitalization as a complication of severe hypercortisolism. Before any therapy for Cushing's syndrome and neuroblastoma could be initiated, the patient died from sepsis and multiorgan failure. We propose that Cushing's syndrome is more complex than what clinicians thought, and that meticulous cerebral imaging studies are crucial.

Key Words:  Cushing's syndrome , hypercortisolism , olfactory neuroblastoma , opportunistic infection

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References 

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PII: S1873-9598(09)70024-9

doi:10.1016/S1873-9598(09)70024-9

International Journal of Gerontology
Volume 3, Issue 1 , Pages 81-84, March 2009

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