Adrenal histoplasmosis presenting as life-threatening adrenal insufficiency

Early diagnosis and prompt institution of antifungal therapy is imperative to prevent mortality as significant majority of patients with adrenal histoplasmosis develop life-threatening adrenal insufficiency.1 A 57-year-old male security guard by occupation presented with 6-month history of fatigue,...

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Bibliographic Details
Published in:BMJ case reports 2021-06, Vol.14 (6), p.e243181
Main Authors: Gaur, Mragank, Sethi, Jasmine, Mitra, Saikat, Gupta, Kirti
Format: Article
Language:English
Subjects:
Abdomen
Adrenal glands
Adrenal Insufficiency - diagnosis
Adrenal Insufficiency - etiology
Antifungal agents
Case reports
Diabetes
Disease
Histoplasmosis - complications
Histoplasmosis - diagnosis
Histoplasmosis - drug therapy
HIV
Human immunodeficiency virus
Humans
Images In
Patients
Tuberculosis
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Summary:Early diagnosis and prompt institution of antifungal therapy is imperative to prevent mortality as significant majority of patients with adrenal histoplasmosis develop life-threatening adrenal insufficiency.1 A 57-year-old male security guard by occupation presented with 6-month history of fatigue, abdominal pain, dizziness on standing, low appetite and significant weight loss. The glucocorticoid-rich adrenal cells and the relative scarcity of reticuloendothelial cells contribute to the tropism of Histoplasma for the adrenal gland.1 Common risk factors include immunosuppressed state such as diabetes, primary immunodeficiency, HIV infection, solid organ transplant recipients, extreme age and patients receiving immunosuppressive drugs. The differential diagnosis of bilateral adrenomegaly with Primary adrenal insufficiency (PAI) includes lymphomas, tuberculosis, fungal infections and metastatic cancer.2 The gold standard for diagnosis remains demonstration of fungal spores with background inflammatory response and isolation of fungus from tissue sample by fungal culture.3 In endemic region, histoplasmosis should always be contemplated as a possibility in a patient presenting with hypoattenuating bilateral adrenomegaly.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-243181