Title: Bilateral Adrenal Histoplasmosis presenting with Primary Adrenal Insufficiency in a tertiary care hospital of East India: An incidental finding reshaping the appropriate therapeutic guideline
Authors: Dr Sarbashis Hota, Dr Tushar Kanti Das, Dr Debashis Chakrabarty, Dr Sanghamitra Mukherjee, Dr Manisha Mahata
DOI: https://dx.doi.org/10.18535/jmscr/v9i1.04
Abstract
Histoplasma capsulatum is a dimorphic fungus causing opportunistic infections in immunocompromised host. Here we present a case of bilateral adrenal histoplasmosis in a 55 years old male, who presented with features of primary chronic adrenal insufficiency.
The patient presented with asthenia and weight loss with persistent hyponatremia and hyperkalemia with a previous history of hospitalization with features of fever, vomiting, abdominal pain and shock. Plasma cortisol level was low with high plasma ACTH; and failure to rise of cortisol level after ACTH challenge test confirmed Primary Adrenal Insufficiency. FNAC from bilaterally enlarged adrenal revealed intracytoplasmic yeast forms of capsulated fungus morphologically diagnosed as Histoplasma.
An overall diagnosis of Primary adrenal Insufficiency resulting from bilateral adrenal Histoplasmosis was made; which prompted initiation of a definitive therapy using systemic antifungals and steroid replacement.
Keywords: Adrenal Insufficiency, Histoplasmosis in India.
