{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:07:11Z","timestamp":1779466031807,"version":"3.53.1"},"reference-count":12,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,4]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    A man in his 80s with small cell lung cancer (SCLC) was admitted to hospital with suspected neutropaenic sepsis after a single cycle of chemotherapy. He failed to improve with broad-spectrum antibiotics and was noted to be lymphopaenic and recurrently hypokalaemic. Serum cortisol level was markedly elevated, suggesting SCLC-related paraneoplastic Ectopic Cushing\u2019s Syndrome (ECS). Induced sputum revealed\n                    <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                    . Despite high-dose co-trimoxazole, he died from respiratory failure due to progressive multilobar pneumonia. We suggest that immunosuppression due to occult SCLC-related hypercortisolaemia resulted in death from\n                    <jats:italic>P. jirovecii<\/jats:italic>\n                    pneumoniae infection and that ECS should be considered as a cause of hypokalaemia and lymphopaenia in patients with SCLC.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-272173","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T15:40:16Z","timestamp":1779464416000},"page":"e272173","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Pneumocystis jirovecii<\/i>\n                    pneumonia infection in a patient with small cell lung cancer complicated by hypercortisolaemia and lymphopaenia"],"prefix":"10.1136","volume":"19","author":[{"given":"Stephen","family":"Pennington","sequence":"first","affiliation":[{"name":"County Durham and Darlington NHS Foundation Trust, Darlington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun Brahmanya","family":"Prasad","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Murphy","sequence":"additional","affiliation":[{"name":"County Durham and Darlington NHS Foundation Trust, Durham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"2026052208400950000_19.5.e272173.1","unstructured":"Navani N , Conibear J , West D , et al . State of the nation report 2024: an audit of care received by patients diagnosed with lung cancer in england and wales during 2022. National Lung Cancer Audit; 2024. Available: https:\/\/www.lungcanceraudit.org.uk\/wp-content\/uploads\/2024\/05\/NLCA-State-of-the-Nation-2024_16.05.24_V2.0.pdf(accessed"},{"key":"2026052208400950000_19.5.e272173.2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.semcancer.2023.05.008","article-title":"Advancements in small cell lung cancer","volume":"93","author":"Lee","year":"2023","journal-title":"Semin Cancer Biol"},{"key":"2026052208400950000_19.5.e272173.3","doi-asserted-by":"crossref","first-page":"6253","DOI":"10.21037\/jtd.2020.03.88","article-title":"Paraneoplastic syndromes in small cell lung cancer","volume":"12","author":"Soomro","year":"2020","journal-title":"J Thorac Dis"},{"key":"2026052208400950000_19.5.e272173.4","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2022.954033","article-title":"Is ectopic Cushing\u2019s syndrome underdiagnosed in patients with small cell lung cancer?","volume":"9","author":"Piasecka","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"2026052208400950000_19.5.e272173.5","doi-asserted-by":"crossref","first-page":"1177125","DOI":"10.3389\/fendo.2023.1177125","article-title":"Management of small cell lung cancer complicated with paraneoplastic Cushing\u2019s syndrome: a systematic literature review","volume":"14","author":"Li","year":"2023","journal-title":"Front Endocrinol"},{"key":"2026052208400950000_19.5.e272173.6","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.tem.2020.04.004","article-title":"The Immune System in Cushing\u2019s Syndrome","volume":"31","author":"Hasenmajer","year":"2020","journal-title":"Trends in Endocrinology & Metabolism"},{"key":"2026052208400950000_19.5.e272173.7","unstructured":"Truong J , Ashurst JV . Pneumocystis jirovecii pneumonia. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482370\/"},{"key":"2026052208400950000_19.5.e272173.8","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofx002","article-title":"Characteristics and Mortality of Pneumocystis Pneumonia in Patients With Cushing\u2019s Syndrome: A Plea for Timely Initiation of Chemoprophylaxis","volume":"4","author":"van Halem","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2026052208400950000_19.5.e272173.9","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.ando.2020.11.002","article-title":"Pneumocystis pneumonia can complicate medical treatment of hypercortisolism even in outpatients with Cushing\u2019s disease","volume":"81","author":"Cristante","year":"2020","journal-title":"Ann Endocrinol (Paris)"},{"key":"2026052208400950000_19.5.e272173.10","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-38618-3","article-title":"Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer","volume":"9","author":"Lee","year":"2019","journal-title":"Sci Rep"},{"key":"2026052208400950000_19.5.e272173.11","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/1759-7714.12403","article-title":"Ectopic Cushing syndrome in small cell lung cancer: A case report and literature review","volume":"8","author":"Zhang","year":"2017","journal-title":"Thorac Cancer"},{"key":"2026052208400950000_19.5.e272173.12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0125"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T15:40:17Z","timestamp":1779464417000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":12,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,22]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2026-272173"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272173","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}