Bilateral Adrenal Histoplasmosis in an Immunocompetent Man

Abstract

Histoplasmosis is a deep fungal infection caused by Histoplasma capsulatum. It presents commonly with transient pulmonary infection but disseminated form can involve any system in the body. Adrenal gland is affected frequently in histoplasmosis but bilateral involvement is unusual. Adrenal histoplasmosis is also common in immunocompromised host. We report a case of bilateral adrenal histoplasmosis in an immunocompetent patient without any features of adrenal insufficiency. Histoplasmosis was diagnosed by fine needle aspiration cytology (FNAC) from adrenal gland. Patient was treated with itraconazole with good response and is currently under follow-up.

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.…”

“…Commonly, patients who develop symptoms are either immunosuppressed or have been exposed to a large dose of inoculum. Clinical spectrum of the disease can vary from primary pulmonary histoplasmosis, primary cutaneous histoplasmosis, and African histoplasmosis to progressive disseminated histoplasmosis [3,5]. Progressive disseminated form causes a chronic illness in immunocompetent hosts while it appears as an acute disease in immunocompromised individuals [3].…”

“…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.…”