Bilateral afrenal nodules due to histoplasmosis in an elderly

Abstract

We report a case history of an 84-year-old elderly male patient that presented with a clinical picture suggestive of adrenal failure and bilateral adrenal nodules detected by abdominal computed tomography. A fine needle-guided biopsy was inconclusive for achieving a final diagnosis. The patient died due to septic shock and the autopsy disclosed histoplasmosis with extensive bilateral necrosis of the adrenal glands. Although the adrenal involvement in chronic disseminated histoplasmosis has been described, there have been few reports of the infection being associated with adrenal insufficiency.

“Polka Dot Macrophages” on cytology of bilateral adrenal masses—Nailing disseminated histoplasmosis

“…Shirangarpure et al, Goswami et al, and Goodwin et al reported adrenal involvement in chronic disseminated form . Carvalho et al and Kaufmann also reported adrenal histoplasmosis . Similar to our findings, Vyas et al also demonstrated adrenal involvement along with an oral ulcer .…”

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

“…Symptoms of adrenal insufficiency include fever, malaise, orthostatic hypotension, nausea, vomiting, hyperkalemia, hyponatremia, eosinophilia, hyperpigmentation, and night sweats and must be recognized and addressed immediately with glucocorticoid and mineralocorticoid therapy to prevent severe, life-threatening complications [7], [11], [12], [13]. However, this syndrome is uncommon [4], [14], [15]. This is due to the fact that disseminated disease usually causes patients to seek medical attention much earlier than the time needed for the 90% destruction of both adrenal glands necessary for the manifestation of clinical adrenal insufficiency [16].…”