Pneumocystis carinii Pneumonia Associated With Solid Ectopic Corticotropin-Producing Tumors

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