Autopsy report of disseminated histoplasmosis: An important differential of adrenal enlargement

A 57-year-old diabetic male, presented with altered sensorium since 2 days. He had a history of weight loss, loss of appetite, intermittent low-grade fever of 6 months duration. He had been administered empirical antituberculous therapy some months ago with no alleviation of symptoms. On examination, he was asthenic, normotensive, and anemic with hepatosplenomegaly. Ultra-sonography abdomen revealed bilateral enlarged adrenals with hepatosplenomegaly. Clinically impression was of tuberculosis disseminated malignancy. He expired within 2 days of admission. At autopsy, both the adrenals were markedly enlarged showing extensive areas of necrosis on the cut surface. Histology showed them to be brimming with colonies of yeast-forms of Histoplasma capsulatum. These organisms were also seen in the spleen, lungs and kidneys. The patient had died of septicemia following disseminated histoplasmosis that was, unfortunately, not diagnosed during his life. Histoplasmosis is amenable to treatment with Amphotericin B. Prompt diagnosis and treatment could have helped in salvaging this patient