Histoplasmosis of bilateral adrenal masses and submandibular lymphadenopathy: other diagnosis besides malignancy and tuberculosis

Abstract

Histoplasma capsulatum is a dimorphic fungus which can cause infection usually in immunocompromised patients. An immunocompetent patient can be affected if he got chronic exposure to soil contaminated with birds or bats guano. We are reporting a case of a 54 years old man, working as trashman at open-air landfill, presented to hospital, with persistent fever and abdominal pain. The patient also complained of enlargement of submandibular lymph nodes. The abdominal ultrasound and CT-scan showed bilateral adrenal masses. Biopsy per laparoscopy of adrenal mass, and aspiration cytology of lymphadenopathy were performed and the results of cyto and histopathology examinations were Histoplasma capsulatum infection. The patient was planned for itraconazole 200 mg bid for 12-24 months. After 6 months of therapy, the patient had no more complains and the lymph nodes have shrinked significantly.