Fatal coccidioidomycosis involving the lungs, brain, tongue, and adrenals in a cirrhotic patient. An autopsy case

Chee, David; Moritz, August W.; Profit, Amanda P.; Agarwal, Apeksha N.; Anstead, Gregory M.

doi:10.1016/j.idcr.2021.e01049

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Chee et al previously demonstrated the involvement of the tongue, lungs, brain, and adrenal glands in an autopsy case (3). Notably, the patient had a clinical history of cirrhosis and lymphocytopenia and died of aspiration pneumonia, even after receiving antifungal treatment.…”

Section: Discussionmentioning

confidence: 96%

Dissemination of Reactivated Coccidioidomycosis Inducing Diffuse Alveolar Damage: A Rare Autopsy Case Report

Onur,

Fidan-Ozbilgin

2023

Academic Forensic Pathology

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Coccidioidomycosis is a fungal infection prevalent in the Southwestern United States and Northern Mexico. Given its rarity and often asymptomatic nature, disseminated coccidioidomycosis frequently omitted in preliminary differential diagnoses. Our case study presents the postmortem results of an individual who had a reactivated coccidioidomycosis, causing diffuse alveolar damage and resulting in his death. This case study underscores the importance of considering coccidioidomycosis in initial differential diagnoses, particularly in patients with prior exposure to the infection and associated risk factors.

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Section: Discussionmentioning

confidence: 96%

Dissemination of Reactivated Coccidioidomycosis Inducing Diffuse Alveolar Damage: A Rare Autopsy Case Report

Onur,

Fidan-Ozbilgin

2023

Academic Forensic Pathology

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Fluconazole

2021

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Adrenal Abscesses: A Systematic Review of the Literature

Gligorijevic

Kaljevic

Radovanović

et al. 2023

JCM

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Objective: To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. Design: Systematic literature review. Methods: We performed a search in the PubMed database using search terms: ‘abscess and adrenal glands’, ‘adrenalitis’, ‘infection and adrenal gland’, ‘adrenal abscess’, ‘adrenal infection’ and ‘infectious adrenalitis’. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. Results: Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with Histoplasma capsulatum (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (p = 0.048). Conclusion: Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, Histoplasma capsulatum is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder.

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Fatal coccidioidomycosis involving the lungs, brain, tongue, and adrenals in a cirrhotic patient. An autopsy case

Cited by 4 publications

References 32 publications

Dissemination of Reactivated Coccidioidomycosis Inducing Diffuse Alveolar Damage: A Rare Autopsy Case Report

Dissemination of Reactivated Coccidioidomycosis Inducing Diffuse Alveolar Damage: A Rare Autopsy Case Report

Fluconazole

Adrenal Abscesses: A Systematic Review of the Literature

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