Case Report of Disseminated Adrenal Histoplasmosis and Secondary Adrenal Insufficiency

Jagadish, Ishitha; Chen, William J; Agarwal, Reema; Shoela, Ramy

doi:10.7759/cureus.30614

Cited by 5 publications

(8 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were 172 cases of histoplasmosis described in 125 reports [ 66 , 69 , 72–87 , 90–99 , 101–182 , 194 , 196 , 197 , 199–206 , 208 , 241–243 ] ( Table 1 ). Half of recipients (74 of 144 [51.4%]) were on MMF [ 73 , 74 , 80 , 83–86 , 92–94 , 96 , 98 , 101–104 , 107–109 , 113–116 , 118–120 , 122 , 126 , 130 , 132–135 , 140 , 143 , 145 , 148–150 , 152 , 153 , 155 , 156 , 159 , 161–165 , 172–174 , 177 , 179 , 181 , 194 , 196 , 197 , 204 ]. T-cell–depleting induction was reported in 23 cases [ 78 , 104 , 107 , 108 , 110 , 113–115 , 118 , 125 , 133 , 146 , 154 , 163 ] while acute rejection occurred in 30 recipients within 1–3 months before symptom onset […”

Section: Resultsmentioning

confidence: 99%

“…One patient treated for 2.6 months had recurrence of tenosynovitis, which required reinitiation of therapy for 11 months [ 129 ]. Nineteen coinfections were described ( Supplementary Material, Appendix 2 ) [ 97 , 101 , 108 , 122 , 128 , 129 , 153 , 159 , 163 , 171 , 180 , 199 , 208 , 243 ]. Of the 42 patients who died [ 74 , 77–79 , 81 , 82 , 84 , 87 , 90 , 95 , 108 , 115 , 127 , 128 , 139 , 141 , 142 , 148 , 153 , 155 , 159–161 , 163 , 164 , 171 , 178 , 179 , 181 , 199–201 , 208 , 241–243 ], the majority had disseminated histoplasmosis (39 of 42 [92.9%]).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation and outcomes of 5 endemic mycoses in SOT recipients. Methods Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (e.g. Coccidioidomycosis or Coccidioides, Histoplasmosis or histoplasma, etc.). We included adult SOT recipients and publications in English or with English translation. Results Among 16 cohort studies that reported on blastomycosis (n=3), coccidioidomycosis (n=5), histoplasmosis (n=4), and various endemic mycoses (n=4), the incidence rates varied: coccidioidomycosis (1.2-5.8%); blastomycosis (0.14-0.99%) and histoplasmosis (0.4-1.1%). There were 204 reports that described 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis. The majority of patients were male (176/261, 67.4%). Transplanted allografts were mostly kidney (191/268, 71.3%), followed by liver (n=39, 14.6%), heart (n=18, 6.7%), lung (n=13, 4.9%), combined kidney-liver, and kidney-pancreas (n=6, 2.7%). In all five endemic mycoses, most patients presented with fever (162/232, 69.8%) and disseminated disease (179/268, 66.8%). Cytopenias were frequently reported for histoplasmosis (71/91, 78.0%), coccidioidomycosis (8/11, 72.7%) and talaromycosis (7/8, 87.5%). Graft loss was reported in 12/136 patients (8.8%). All-cause mortality was reported in 71/267 (26.6%); half (n=34, 50%) of the deaths were related to the underlying mycoses. Conclusions Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high rate of all-cause mortality, including many that were attributed to endemic mycoses.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Laboratory abnormalities are frequent. These include pancytopenia, transaminitis, elevated lactate dehydrogenase, hypercalcemia and elevated inflammatory markers (e.g., ferritin) [41,[52][53][54]. Histoplasmosis-induced hemophagocytic lymphohistiocytosis (HLH) has been reported [55].…”

Section: Clinical Presentationmentioning

confidence: 99%

Histoplasmosis in Solid Organ Transplantation

Barros,

Wheat

2024

JoF

View full text Add to dashboard Cite

Histoplasma capsulatum, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. It has a broad global distribution with shifting epidemiology during recent decades. While in immunocompetent individuals infection is usually self-resolving, solid organ transplant recipients are at increased risk of symptomatic disease with dissemination to extrapulmonary tissue. Diagnosis of histoplasmosis relies on direct observation of the pathogen (histopathology, cytopathology, and culture) or detection of antigens, antibodies, or nucleic acids. All transplant recipients with histoplasmosis warrant therapy, though the agent of choice and duration of therapy depends on the severity of disease. In the present article, we describe the pathogenesis, epidemiology, clinical manifestations and management of histoplasmosis in solid organ transplant recipients.

show abstract

“…Acute pulmonary infection is more common in pediatric age groups. Disseminated histoplasmosis is more common in immunocompromised individuals 2 – 4 . Herein, we report a case of a 53-year-old immunocompetent male with delayed presentation of disseminated histoplasmosis in both adrenal glands, diagnosed through histopathological evaluation of the adrenal gland and treated with liposomal amphotericin B and itraconazole.…”

Section: Introductionmentioning

confidence: 99%

Disseminated adrenal histoplasmosis in an immunocompetent adult from Nepal: a case report

Oli,

Poudel,

Ranabhat

2023

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

Introduction: Histoplasmosis is caused by the environmental fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis can present as a disseminated infection that can involve the liver, lymph nodes, lungs, and adrenal glands. Disseminated histoplasmosis affecting the adrenal glands in an immunocompetent individual is a rare infection. Case presentation: A 53-year-old male without HIV complained of weight loss of 15 kg in 6 months. Computed tomography (CT) scan of the abdomen was done, which showed bilateral adrenal gland hyperplasia with hepatosplenomegaly. Endoscopic ultrasound fine needle aspiration of the adrenal gland revealed numerous budding yeast forms of Histoplasma intracellularly within the macrophages. A diagnosis of disseminated adrenal histoplasmosis was made. Liposomal amphotericin B and itraconazole therapy was started. Discussion: Disseminated histoplasmosis is commonly present in immunocompromised individuals. Immunocompetent individuals may also present with the disseminated form of the disease, which typically involves the adrenal glands. CT scan of the abdomen shows bulky adrenal glands with normal configuration, peripheral enhancement, and central hypodensities due to necrosis and/or hemorrhage. This might be a common presentation in other disseminated infections. Therefore, a definitive visualization of H. capsulatum in tissue specimens is the best method to confirm the diagnosis in a patient. Conclusion: Physicians must be suspicious of disseminated adrenal histoplasmosis in patients presenting with enlarged adrenal glands, even in immunocompetent individuals who are from endemic regions. Histopathological or cytological evaluation is the best method to establish a diagnosis.

show abstract

Case Report of Disseminated Adrenal Histoplasmosis and Secondary Adrenal Insufficiency

Cited by 5 publications

References 10 publications

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Histoplasmosis in Solid Organ Transplantation

Disseminated adrenal histoplasmosis in an immunocompetent adult from Nepal: a case report

Contact Info

Product

Resources

About