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Category: Volume 10 Issue 11 November 2022
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Title: A Rare Case of Adrenal Insufficiency due to Histoplasmosis

Authors: Dr Sumesh Nirwan, Dr Simrat Kaur, Dr Lokendra S Mishra, Dr Nitin Raisinghani

 DOI: https://dx.doi.org/10.18535/jmscr/v10i11.03

Abstract

A 60 years old male an businessman living in Narnaul district, Haryana, known Hypertensive and Diabetic was admitted in SDMH with complains of severe generalized weakness, diffuse abdominal pain and H/O intermittent low grade fever for 4 months with H/O of weight loss .There was also complain of blackish discolouration of skin over the face, knuckles, elbow, buccal mucosa and chest which had developed over the last month. With differential diagnosis of tuberculosis and malignancy initial workup was done. The initial workup revealed primary adrenal insufficiency and bilateral adrenal space occupying lesion .Further investigation was done and finally on histopathological examination Histoplasmosis was diagnosed and patient was treated with antifungal with clinical recovery.

Our case was rare presentation of isolated adrenal histoplasmosis with adrenal insufficiency in a immunocompetent host in north western region of Rajasthan.

References

  1. Rog CJ, Rosen DG, Gannon FH. Bilateral adrenal histoplasmosis in an immunocompetent man from Texas. Med Mycol Case Rep. 2016;14:4-7.
  2. Fayyaz J, Vydyula R, Walczyszyn MP, Lessnau KD, Talavera F, Mosenifar Z. Histoplasmosis, Medscape,Updated:21st Sep 2018. Available from: http://emedicine.medscape.com/article/299054.
  3. Wahab NA, Mohd R, Zainudin S, Kamaruddin NA. Adrenal involvement in histoplasmosis. EXCLI J 2013;12:1-4.
  4. Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai D.Disseminated histoplasmosis. J Assoc Physicians India. 2005;53:185–189.
  5. Rajesh KF, Warrier V, Gayathri R, Chellenton J,Geetha P, Thulaseedharan NK. A case of histoplasmosis. Calicut Med J. 2010; 8(2):e7.
  6. Jaiswal S, Vij M, Chand G, Misra R, Pandey R.Diagnosis of adrenal histoplasmosis by fineneedle aspiration cytology: an analysis based onfive cases. Cytopathology: official journal of the British Society for Clinical Cytology. 2011;22:323–328.
  7. Goodwin RA, Jr, Shapiro JL, Thurman GH, Thurman SS, Desprez RM. Disseminated histoplasmosis: clinical and pathologic correlations. Medicine. 1980;59:1–33.
  8. Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison's Principles of Internal Medicine, 21e. McGraw Hill; 2022.
  9. Butta H, Chatterjee S, Mendiratta L, Gilotra K, Jadhav L, Rawat V, Sardana R. Bilateral adrenal histoplasmosis in a diabetic patient: A case report and review of cases in India. Apollo Med 2019;16:109-13
  10. Niknam N, Malhotra P, Kim A, Koenig S. Disseminated histoplasmosis presenting as diabetic keto-acidosis in an immunocompetent patient. BMJ Case Rep 2017;2017. pii: bcr2016217915

Corresponding Author

Dr Sumesh Nirwan

Senior Resident, Dept. of Internal Medicine, SDMH, Jaipur