Adrenal histoplasmosis: An unusual cause of adrenomegaly

Abstract

Histoplasmosis is a geographically restricted form of fungal infection. Adrenal involvement is seen in disseminated disease but sometimes it may be the only site of demonstrable disease. Early diagnosis and treatment may save the patient from catastrophic adrenal insufficiency. We present two patients showing bilateral adrenomegaly on ultrasonography and contrast-enhanced CT, and was diagnosed to have histoplasmosis on fine-needle aspiration cytology.

Adrenal histoplasmosis in immunocompetent patients presenting as adrenal insufficiency

“…The differential diagnoses of bilateral adrenomegaly are metastasis, lymphoma, adrenal haemorrhage, sarcoidosis and infections that include histoplasmosis, tuberculosis, cryptococcosis, coccidioidomycosis and blastomycosis (12). Bilateral involvement with adrenal enlargement is common in malignancy, but adrenal insufficiency is very uncommon, accounting to <1% of cases of adrenal…”

Histoplasmosis presenting as hypoadrenalism

“…2 On ultrasonography, they may be uniformly hypoechoic or show heterogeneous echo pattern Bilateral symmetrical adrenomegaly with preservation of gland contour, central hypodensity with peripheral rim enhancement and presence of calcification has been described in CT. 2 In this case, CT revealed bilateral adrenal masses with central hypoattenuation and minimal peripheral rim enhancement.…”

“…1,2 Histoplasmosis is found world wide and is endemic in parts of the USA, West Indies, Africa and the Far East. 3 Most cases from India have been reported from the Gangetic plains.…”

Progressive disseminated histoplasmosis presenting like chronic parenchymal liver disease with ascites: a rare case report and discussion

“…Meningitis or focal brain lesions, oral mucosal & gastrointestinal ulcers, adrenal insufficiency can also be there. 4 Fibrosing mediastinitis is an unusual but serious complication of histoplasmosis. It can lead to superior vena cava syndrome, obstruction of pulmonary vessels and airway, recurrent pneumonia, hemoptysis, or respiratory failure.…”