Bilateral adrenal histoplasmosis in an immunocompetent man

Benevides, Carlos Frederico Lopes; Durães, Ronilson Oliveira; Aquino, Bianca; Schiavon, Leonardo de Lucca; Narciso-Schiavon, Janaína Luz; Buzzoleti, Fernando da Costa

doi:10.1590/s0037-86822007000200017

Cited by 17 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…48 cases (65.8%) were found bilaterally, 12 cases (16.4%) were found unilaterally, and 13 cases (17.8%) lacked proper documentation to make this determination. These statistics seem to dispute previously held notion that adrenal histoplasmosis is most often found unilaterally [8]. In 33 cases (~45%), clinical and laboratory findings were consistent with a diagnosis adrenal insufficiency.…”

Section: Discussioncontrasting

confidence: 60%

“…The liver, spleen, lymph nodes, bone marrow, and adrenal glands are some of the most common organs involved, resulting in a wide variety of presentations and syndromes. Symptoms often include fatigue, weight loss, anorexia, fever, nausea, and vomiting [7], [8]. Adrenal involvement is particularly common, especially in immunocompetent patients [5].…”

Section: Discussionmentioning

confidence: 99%

“…May Graunwald Giemsa stains can be performed on air-dried smears, Papanicoulaou stain is often used on alcohol-fixed smears, periodic acid Schiff (PAS) and Gomori-Grocott methenamine silver (GMS) are used to identify fungal elements, and Ziehl Neelsen stain is used to identify the presence of acid fast bacilli [12], [13]. Common findings indicative of Histoplasma infection microscopically include granulomatous inflammation with caseous necrosis (mononuclear cell infiltrates and multinucleated giant cells), oval or spherical hyaline granules measuring 2–4 µm in diameter, or uninucleate, intracellular (in macrophages) or extracellular yeasts with single buds attached at narrow bases measuring 3–5 µm in diameter and often occurring in clusters as well as positive Histoplasma cultures [7], [8], [12], [13]. Furthermore, given that mycobacteria and fungi are the most common microorganisms to disseminate, cultures should be prepared for these two groups of organisms from the aspirate [12], [13].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Rog

Rosen

Gannon

2016

Medical Mycology Case Reports

View full text Add to dashboard Cite

Disseminated histoplasmosis affecting the adrenal gland(s) of immunocompetent adults is a very rare infection. Here, we present a case of bilateral adrenal histoplasmosis in an immunocompetent, 62-year-old gentleman from Texas along with a brief review of the published literature. Given the risk of patient decompensation secondary to adrenal insufficiency and the wide availability of effective treatments, adrenal histoplasmosis must be considered even in immunocompetent adults who acquire adrenal masses.

show abstract

Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Rog

Rosen

Gannon

2016

Medical Mycology Case Reports

View full text Add to dashboard Cite

show abstract

“…15 Clinical manifestations include chronic fatigue, weight loss, anorexia and fever of variable duration. [16][17][18] However, adrenal insufficiency is uncommon. 19 We also encountered adrenal insufficiency in one among ten patients with adrenal histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Singh¹

2017

View full text Add to dashboard Cite

Background:There have been sporadic reports of histoplasmosis from India. Although traditionally considered a disease of immunocompromised hosts, immunocompetent patients presenting with adrenal histoplasmosis have been reported. Endoscopic ultrasound (EUS) provides easy and safe approach to adrenal glands for fine needle aspiration. Methods: We report 10 cases of adrenal histoplasmosis diagnosed by endoscopic ultrasound (EUS) guided FNA. The mean age at diagnosis was 54 ± 9 years, all were males. Eight patients were immunocompetent while two had cirrhosis; none of them was retrovirus positive. All patients presented with fever and weight loss, 8 had bilateral adrenal enlargement while 2 had isolated left adrenal enlargement. EUS features included hypoechoic (30%) or heteroechoic (70%) adrenal glands, presence of hypoechoic areas suggestive of necrosis within the gland was identified in 40% of these patients. Adrenal insufficiency was present in 1 patient (10%) which persisted even after successful treatment. Conclusion: Adrenal histoplasmosis should be considered even in immunocompetent hosts presenting with constitutional symptoms and adrenal enlargement. EUS guided FNA is a safe and accurate modality for adrenal sampling.

show abstract

“…It is widely recognized that a prolonged treatment of at least 1 year is necessary due to Histoplasma's adeptness at persisting latently within the human body. 11 For this reason in this case the duration of antifungal therapy is planned to be maintained for at least 12-18 months according to patient's response. In this case though the patient showed slow regression of adrenal mass as evidenced by imaging but the patient had dramatic improvement of the symptoms, body weight and wellbeing.…”

Section: Discussionmentioning

confidence: 99%