RT Journal Article
SR Electronic
T1 Addison’s disease with primary hypothyroidism in a case of visceral leishmaniasis and HIV coinfection
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e238488
DO 10.1136/bcr-2020-238488
VO 14
IS 3
A1 Monu Rani
A1 Rakesh Garg
A1 Venkatesh Darshan Agraharabachalli Nanjunde
A1 Rajesh Rajput
YR 2021
UL http://casereports.bmj.com/content/14/3/e238488.abstract
AB A 41-year-old man presented with vomiting and loose stools. He had a history of long-term intermittent fever, generalised skin hyperpigmentation, dragging sensation in the left hypochondrium and unintentional weight loss. He was receiving combination antiretroviral therapy since 2010 for HIV infection. He also received antitubercular therapy for tuberculous spondylitis. During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison’s disease) and primary hypothyroidism, as a rare and unusual presentation.