Adrenal histoplasmosis in immunocompetent patients presenting as adrenal insufficiency

Gajendra, Smeeta; Sharma, Ridhima; Goel, Shalini; Goel, Ruchika Kumar; Lipi, Lipika; Sarin, Hemanti; Guleria, Mridula; Sachdev, Ritesh

doi:10.5146/tjpath.2015.01349

Cited by 18 publications

(53 citation statements)

References 7 publications

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“…Similar to our findings, Vyas et al also demonstrated adrenal involvement along with an oral ulcer . Gajendra S et al also studied 12 cases of adrenal histoplasmosis in immunocompetent host from North India and found bilateral adrenal involvement in 10 cases with alveolar involvement in one case …”

Section: Discussionsupporting

confidence: 90%

“…Clinically adrenal histoplasmosis presents with chronic fatigue, weight loss, anorexia, and fever . On ultrasonography, the lesions may show a uniformly hypoechoic to heterogeneous echo pattern with preservation of normal adrenal gland outlines . The range of CT findings may include minimal enlargement with faint flecks of calcium, moderate enlargement with focal low attenuation nodules or massive enlargement with large areas of necrosis or dense calcification .…”

Section: Discussionmentioning

confidence: 99%

“…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 the absence of serological tests, FNAC serves as a reliable investigation for accurate and swift diagnosis of disseminated histoplasmosis, hence instituting early treatment.…”

Section: Discussionmentioning

confidence: 99%

“…On histopathology, histoplasma incites a granulomatous reaction with multinucleated giant cells and caseation necrosis in the adrenal gland. The spectrum of adrenal histoplasmosis ranges from a mild form exhibiting few cortical foci of parasitized macrophages to bilateral adrenomegaly with extensive caseation and granulomatous reaction to extensive infarcts or calcified mass lesion that may mimic tuberculosis or metastasis …”

Section: Discussionmentioning

confidence: 99%

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

Grover

Selhi

Sood

et al. 2017

Diagnostic Cytopathology

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Histoplasma capsulatum is a saprophytic fungus that in immunocompetent individuals causes self-limited pulmonary infection; however, in immunosuppressed patients involvement of the reticuloendothelial system, alimentary tract, urinary tract, and central nervous system is fairly common. Rarely patients present with bilateral adrenal masses which mimic tuberculosis and metastasis on radiology because of associated central necrosis. Ultrasound guided FNAC aided by special stains like Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) may help in early diagnosis in such dubious cases. Polka dot macrophages were the clue to diagnosis of histoplasmosis on toluidine blue rapid staining, Hematoxylin & Eosin, and Pap stained smears. We report this case because of its rarity, diagnostic difficulty on radiology, and rapidity of diagnosis by FNA due of its characteristic cytomorphology.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Grover

Selhi

Sood

et al. 2017

Diagnostic Cytopathology

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show abstract

“…However, histoplasmosis, other fungal infections (blastomycosis, paracoccidioidomycosis, cryptococcosis, and coccidioidomycosis), sarcoidosis, subacute adrenal hemorrhage, and adrenal abscess must also be considered [3], [8], [17], [18].…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Rog

Rosen

Gannon

2016

Medical Mycology Case Reports

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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.

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Primary adrenal insufficiency due to bilateral infiltrative disease

et al. 2018

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In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

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Adrenal histoplasmosis in immunocompetent patients presenting as adrenal insufficiency

Cited by 18 publications

References 7 publications

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

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

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Primary adrenal insufficiency due to bilateral infiltrative disease

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