Patients with lower level of ACTH (survival <i>vs</i> mortality: 213.1 ± 159.0 <i>vs</i> 554.7 ± 401.0 pg/ml, P = 0.04), no co-infection, underwent CS surgery, and received antibiotic therapy for more than 6 months, had more possibilities to survive.<h4>Conclusions</h4>Nocardia infection should be cautioned when a patient of CS presented with abnormal chest radiographs. The gene discussed is POMC; the disease is Cowden syndrome 1.