Imaging spectrum in disseminated histoplasmosis: Case report and brief review

Abstract

The clinical manifestations of chronic disseminated histoplasmosis are non-specific and resemble those of other chronic infections and malignancies. We report the radiographic, sonographic and contrast-enhanced CT appearances of histoplasmosis in an adult male with non-insulin dependent diabetes mellitus, who was HIV negative and presented with weight loss and pyrexia. Imaging studies simulated tuberculosis with mediastinal lymphadenopathy, bilateral fibrotic lung lesions, hepatomegaly and bilateral hypoattenuating adrenal enlargement, without clinical or laboratory evidence of hypoadrenalism. Computed tomography-guided fine-needle aspiration biopsy of adrenal glands revealed Histoplasma capsulatum. We report our experience to increase awareness of the imaging spectrum of disseminated histoplasmosis and its similarity to tuberculosis as, with increasing incidence of AIDS, the chances of these infections are likely to increase. Moreover, awareness of this entity is important because it is known that untreated disseminated histoplasmosis is fatal.

Adrenal histoplasmosis in immunocompetent patients presenting as adrenal insufficiency

“…Diagnosis of disseminated disease can also be done on bone marrow examination, as in one of our cases (case 8). Diagnostic accuracy has improved greatly with the use other laboratory tests such as serology, complement fixation, a precipitation test, latex particle agglutination test, agar-gel double immune-diffusion test, radioimmunoassay, polymerase chain reaction and microscopy (9). However, the gold standard for diagnosis of histoplasmosis is tissue culture (10).…”

Histoplasmosis presenting as hypoadrenalism

“…These tests can be helpful in differentiating histoplasmosis from tuberculosis. 8 Histoplasma capsulatum is an intracellular dimorphic fungus which is commonly seen with in the cytoplasm of the macrophages and exhibit narrow based budding. 9 In FNAC these organisms can also be seen extracellularly as the fragile cytoplasm of the macrophages may get disrupted at the time of making smears.…”

A Case of Adrenal Histoplasmosis

“…These symptoms are nonspecific and resemble other chronic infections and malignancies. 2,4 Adrenal involvement is usually sequelae of previous infection. Though very rare, cases of disseminated histoplasmosis have been reported.…”

“…Nevertheless, they have been reported from endemic areas, particularly among immune-compromised individuals and in those at the extreme of age. [2][3][4] There is high incidence of liver, spleen, lymph node, bone marrow and adrenal involvement. 2 The clinical presentation of the disseminated disease includes pyrexia, anorexia, nausea, vomiting, weight loss and fatigue.…”