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Case report
Bilateral adrenal histoplasmosis presenting as adrenal insufficiency in an immunocompetent host in the Philippines
  1. Ma Carrissa Abigail Roxas1,
  2. Mark Anthony Santiago Sandoval1,
  3. Maria Sonia Salamat2,
  4. Patrick Joseph Matias3,
  5. Nikko Paolo Cabal4 and
  6. Samantha S Bartolo2
  1. 1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2Department of Medicine, Division of Infectious Disease, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  3. 3Department of Surgery, Division of Urology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  4. 4Department of Laboratories, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Ma Carrissa Abigail Roxas; abiroxas{at}gmail.com

Abstract

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.

  • adrenal disorders
  • tropical medicine (infectious disease)
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Footnotes

  • Contributors MCAR, MASS, MSS, PJM, NPC, SSB: involved in the multidisciplinary care of patient; conceptualised, acquired, analysed the data; drafted, revised, finalised the case report; agreed to be accountable for the article and ensured that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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