A case of clinically inapparent bilateral adrenal histoplasmosis in an Immunocompetent person

Abstract

Histoplasmosis presenting as bilateral large adrenal masses is rare. We describe the case of a 35-year-old male with bilateral adrenal masses which turned out to be histoplasmosis on biopsy, so the masses were treated with antifungal agents. We describe the case for its rarity.

“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 .…”

“…While smearing, the fragile cytoplasm of the macrophages may get disrupted; hence this organism can also be seen extracellularly . It is surrounded by a clear ring of space that resembles a capsule, hence the misnomer, H. capsulatum . Many scattered stripped epithelial cells of adrenal gland origin, scattered lipid globules and inflammatory cells may be seen against a dense necrotic amorphous background .…”

“…In immunocompromized patients, it may disseminate hematogenously to gastrointestinal tract, kidneys, lymphnode, reticuloendothelial system, central nervous system, bone marrow, and so on . Dissemination to adrenal glands is a rare occurrence and usually a sequel of previous infection . We present a case of adrenal histoplasmosis masquerading as tuberculosis that was diagnosed on fine‐needle aspiration cytology (FNAC).…”

“…3 Dissemination to adrenal glands is a rare occurrence and usually a sequel of previous infection. 4,5 We present a case of adrenal histoplasmosis masquerading as tuberculosis that was diagnosed on fine-needle aspiration cytology (FNAC).…”