Xanthogranulomatous Adrenalitis: A Case Report of a Diabetic, 55-Year-Old Male

Abstract

We report a rare case of xanthogranulomatous adrenalitis in a 55-year-old man. The patient presented to the hospital with fever, nausea, and right flank pain. His medical history was significant for diabetes and an adrenal mass that was detected 6 years prior to presentation during a computed tomography (CT) scan for trauma secondary to a motor vehicle collision. The mass was thought to be a myelolipoma. Magnetic resonance imaging (MRI) revealed a 12-cm right adrenal mass that was considered suspicious for carcinoma, which was surgically excised and cultured intraoperatively. The cultures subsequently grew methicillin-resistant Staphylococcus aureus (MRSA). Grossly, the adrenal mass was an encapsulated, necrotic lesion with surrounding areas of fat necrosis. On histologic examination, the tissue showed sheets of histiocytes, lymphocytes, and plasma cells diffusely involving the adrenal gland along with bright yellow lipofuscin crystals in a background of necrosis and fibrosis.

Xanthogranulomatous adrenalitis masquerading as a functioning adrenocortical malignancy: a case report

“…Sepsis is generally believed to be the inciting event for the process, and in our case systemic staphylococcal septicemia was present, similar to previous reports. 6 However, in contrast to previous studies, the present case had isolation of MSSA strains, instead of methicillin-resistant infection. The clinical features described are usually nonspecific with a palpable mass and dull aching flank pain.…”

“…There has been mention of the association of diabetes and immunosuppression with XA in the literature. 6 In another report by Trinavarat et al, 7 neonatal adrenalitis due to XP was speculated to be triggered by adrenal hemorrhage following birth asphyxia and neonatal sepsis. Although it is believed that XP follows a benign course, there can be significant local infiltration into adjacent organs, which makes it indistinguishable from adrenal neoplasms in most scenarios.…”

The Environmental Pollutant Tributyltin Chloride Disrupts the Hypothalamic-Pituitary-Adrenal Axis at Different Levels in Female Rats

“…In agreement with these previous findings, both groups of TBT rats displayed an increase in collagen deposition in the adrenal cortex in a time-dependent manner. Reed et al (98) reported that adrenal fibrosis was associated with adrenal inflammation in a 55-year-old man. Thus, the adrenal abnormalities observed in both groups of TBT rats could be associated with the direct toxic effects of TBT.…”

Xanthogranulomatous epididymo-orchitis: A single-institutional case series and systematic review

“…Role of Staphylococcus aureus in the pathogenesis of xanthogranulomatous adrenalitis has also been emphasized by one of the authors. [ 34 ] Blunt trauma in the testis may lead to XGEO through the invasion of macrophages in response to trauma-induced hematoma[ 25 27 ] Testicular ischemia secondary to hypertensive arteriosclerosis in adults and in children after endarteritis has also been reported in cases with XGEO. At the site of tissue damage, there is an increased expression of monocyte chemoattractant protein-1 (MCP-1) and interleukin 6 (IL-6).…”