A Case of Adrenal Histoplasmosis

Afsana, Faria; Hossain, Kazi Nazmul; Tareque, Ashfaq; Amin, Mohammad Feroz; Pathan, Faruque

doi:10.3329/birdem.v8i1.35046

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Treatment for the disseminated disease, including adrenal histoplasmosis, is depending on the severity of the infection and the condition of the patient. Amphotericin is used initially in severe infections and later needs to be converted to maintenance long-term oral itraconazole therapy [1,4,8]. Our patient was started on oral itraconazole therapy which was available to us.…”

Section: Discussionmentioning

confidence: 97%

“…It is a very safe and effective way of diagnosing the condition. USS or CT-guided biopsy and periodic acid-Schiff (PAS) or GMS staining also can be used in some cases [1,4,7,8]. Histoplasma serum and urine antigen assays, polymerase chain reaction assays, blood cultures, immunoprecipitation antibodies, and complement fixing antibodies also support the diagnosis [9].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report

Jayathilake

Kumarihamy

Ralapanawa

et al. 2020

Case Reports in Medicine

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Histoplasmosis is caused by Histoplasma capsulatum, and commonly it causes an asymptomatic illness. Although Histoplasma is the commonest organism to infect adrenal glands, disseminated histoplasmosis in an immune-competent host leading to adrenal insufficiency is rare in current literature. Here, we report a case of possible disseminated histoplasmosis leading to adrenal crisis in a young Asian immunocompetent male. A 42-year-old Sri Lankan male with noninsulin-dependent diabetes mellitus presented with constitutional symptoms and feverishness for three weeks’ duration. He was found to have hepatosplenomegaly with bilateral adrenal masses and pancytopenia. One week later, he developed severe vomiting and hemodynamic collapse and was found to have suppressed adrenal functions. Ultrasound-guided biopsy of adrenals showed fungal spores morphologically similar to Histoplasma. He was started on oral itraconazole and adrenal replacement therapy. He improved symptomatically with treatment and currently is on regular clinic follow-up with a plan to continue antifungal therapy for at least one year to prevent a relapse. Fungal infections, especially histoplasmosis, need to be considered in all immunocompetent patients with compatible history and bilateral adrenal masses. Adrenal insufficiency needs to be promptly diagnosed and treated to prevent Addisonian crisis in these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report

Jayathilake

Kumarihamy

Ralapanawa

et al. 2020

Case Reports in Medicine

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“…Among them, two were HIV positive and had diarrhea, and one had an associated upper respiratory tract infection that might precipitate adrenocortical insufficiency. Alam et al and Afsana et al from Bangladesh reported two different cases of adrenal insufficiency related to chronic disseminated histoplasmosis as a rare presentation [9,14].…”

Section: Discussionmentioning

confidence: 99%

Clinical, Laboratory Characteristics, and Treatment Outcomes of Histoplasmosis Among Patients Admitted to a Referral Tertiary Care Hospital in Bangladesh

Been Sayeed,

Rahman,

Moniruzzaman

et al. 2023

Cureus

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Background: Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum (H. capsulatum). Systemic involvement of histoplasmosis usually occurs in immune-compromised patients, patients with AIDS, or those taking immunosuppressive therapy. The present study aims to describe the clinical and laboratory characteristics and treatment outcome of histoplasmosis as the diagnosis is challenging and management protocol differs.Method: This retrospective study was done using a data registry at the medicine department of Dhaka Medical College Hospital. Here, patients received the standard treatment of histoplasmosis. Here, patients received the standard treatment of histoplasmosis, and clinical outcome was assessed at 3 months following starting standard treatment.Result: A total of nine patients were enrolled, six (66.7%) had systemic histoplasmosis. Three were poultry workers, and the most common comorbidity was diabetes 3 (33.3%). Fever 7 (77.7%), weight loss 6 (66.7%), hyperpigmentation 5 (55.5%), cough 4 (44.4%), oral ulceration 4 (44.4%), lymphadenopathy 4 (44.4%), and hypotension 3 (33.3%) were the most common clinical presentations. Seven (77.7%) out of nine patients were cured of histoplasmosis; however, one died before initiating antifungal medications and another one died due to a hypersensitivity reaction to liposomal amphotericin B.Conclusion: For local histoplasmosis, oral itraconazole is an effective antifungal medication. However, in disseminated Histoplasmosis, liposomal amphotericin B followed by oral itraconazole is still one of the preferable and effective treatment options. Clinicians should be aware of hypersensitivity reactions of liposomal amphotericin B and its management before giving an infusion.

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Histoplasmosis of bilateral adrenal masses and submandibular lymphadenopathy: other diagnosis besides malignancy and tuberculosis

Salim

Tanzil

Permata

et al. 2019

J. Phys.: Conf. Ser.

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Histoplasma capsulatum is a dimorphic fungus which can cause infection usually in immunocompromised patients. An immunocompetent patient can be affected if he got chronic exposure to soil contaminated with birds or bats guano. We are reporting a case of a 54 years old man, working as trashman at open-air landfill, presented to hospital, with persistent fever and abdominal pain. The patient also complained of enlargement of submandibular lymph nodes. The abdominal ultrasound and CT-scan showed bilateral adrenal masses. Biopsy per laparoscopy of adrenal mass, and aspiration cytology of lymphadenopathy were performed and the results of cyto and histopathology examinations were Histoplasma capsulatum infection. The patient was planned for itraconazole 200 mg bid for 12-24 months. After 6 months of therapy, the patient had no more complains and the lymph nodes have shrinked significantly.

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A Case of Adrenal Histoplasmosis

Abstract: Histoplasmosis is a fungal disease that may present as chronic pulmonary infection

Cited by 4 publications

References 7 publications

A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report

A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report

Clinical, Laboratory Characteristics, and Treatment Outcomes of Histoplasmosis Among Patients Admitted to a Referral Tertiary Care Hospital in Bangladesh

Histoplasmosis of bilateral adrenal masses and submandibular lymphadenopathy: other diagnosis besides malignancy and tuberculosis

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