Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Abstract

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.

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

“…Although it is not endemic in Sri Lanka, Histoplasma is endemic in some parts of Southeast Asia, Australia, Central and Northern America, Eastern and Southern Europe, and Africa [1][2][3]5]. Histoplasma grows as a mycelium at ambient temperatures especially in moist acidotic soils in river banks and caves and in bat and bird droppings [2][3][4][5]. When the microsporidia are inhaled, it changes its form and grows as a yeast within the alveolar macrophages.…”

“…Histoplasmosis is usually a self-limiting disease in immunocompetent individuals, but rarely it can cause progressive disseminated disease in pediatric, geriatric, and in immunocompromised populations [2,4]. Normally, it presents as an asymptomatic self-limiting pulmonary infection or a mild flu-like illness [1][2][3][4]. Commonly, patients who develop symptoms are either immunosuppressed or have been exposed to a large dose of inoculum.…”

“…Progressive disseminated form causes a chronic illness in immunocompetent hosts while it appears as an acute disease in immunocompromised individuals [3]. Progressive disseminated histoplasmosis is more common among immunosuppressed, and it can involve any organ system including the reticuloendothelial system, lungs, bone marrow, kidneys, adrenal glands, gastrointestinal system, eyes, and brain [1][2][3][4][5][6].…”

“…Histoplasmosis is caused by a thermally dimorphic fungus Histoplasma capsulatum, which is rarely encountered in Sri Lanka. Mainly, it causes an asymptomatic self-limiting pulmonary infection [1][2][3][4] but can cause various clinical manifestations ranging from pulmonary histoplasmosis to progressive disseminated disease [3,5]. Symptomatic disease is more common among immunosuppressed individuals.…”

Cutaneous Histoplasmosis and Role of Direct Microscopy-A Case Report

“…These nonspecific symptoms can resemble other chronic infections including tuberculosis and malignancies and can lead to diagnostic dilemma [5,6]. The organs commonly involved in disseminated histoplasmosis are liver, spleen, adrenal gland, bone marrow and lymph node [2,7]. The skin involvement, commonly seen in HIV positive cases, is rare in disseminated disease and occurs in only 6% of patients in the form of hyperpigmented, erythematous nodule, papule, or ulcerative lesions [8].…”