Open AccessBilateral adrenal histoplasmosis presenting as adrenal insufficiency in an immunocompetent host in the Philippines
Author(s) -
Ma Carrissa Abigail Roxas,
Mark Anthony Sandoval,
Maria Sonia S. Salamat,
Patrick Joseph Matias,
Nikko Paolo Cabal,
Samantha S Bartolo
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2020-234935
Subject(s) - histoplasmosis , medicine , adrenal insufficiency , adrenal disorder , histoplasma , rare disease , adrenal gland , disease , weakness , pathology , dermatology , surgery , histoplasma capsulatum , insulin resistance , glucose homeostasis , obesity
Disseminated histoplasmosis, with the adrenal glands as being the only site of demonstrable disease in an immunocompetent adult, is a rare infection leading to adrenal insufficiency. This disease carries high mortality when unrecognised. We describe the first reported case of adrenal histoplasmosis in the Philippines in a 72-year-old immunocompetent, Filipino man who presented with a 3-month history of intermittent flank pain, weight loss and generalised weakness. His imaging demonstrated bilateral adrenal masses on ultrasonography and contrast-enhanced CT scan. The initial impression was adrenal cancer, however, fine-needle aspiration cytology revealed the presence of yeast cells and blood culture grew Histoplasma capsulatum The diagnosis of the case represents a diagnostic challenge in immunocompetent individuals because they manifest with non-specific symptoms. A heightened suspicion is therefore needed to prevent significant morbidity and mortality.