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Histoplasmosis presenting with progressively worsening backache--a case report
S R Lachmanan1, O Haniza, A N Hisham
1Department of Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
Annals of the Academy of Medicine, Singapore
|January 31, 2002
Summary
Bilateral adrenal enlargement, often linked to cancer, can present as back pain. This case highlights disseminated histoplasmosis as a cause, successfully treated with itraconazole.
Area of Science:
- Infectious Diseases
- Endocrinology
- Radiology
Background:
- Bilateral adrenal enlargement is commonly associated with metastatic cancer, especially in patients with significant weight loss.
- This case report focuses on an unusual presentation of adrenal enlargement.
- Backache was a primary symptom, prompting further investigation.
Observation:
- A 55-year-old male with diabetes and ischemic heart disease presented with worsening back pain, fever, anorexia, and weight loss.
- Physical examination revealed nodular lesions in the oral cavity.
- CT scans confirmed bilateral adrenal masses.
Findings:
- Biopsies of palatal nodules identified histiocytes with Histoplasma organisms, confirming disseminated histoplasmosis.
- The adrenal masses were attributed to fungal infection rather than malignancy.
- The patient responded well to antifungal therapy.
Implications:
- Disseminated histoplasmosis should be considered in the differential diagnosis of bilateral adrenal enlargement, particularly in endemic areas or in immunocompromised individuals.
- Prompt diagnosis and treatment with antifungal agents like itraconazole can lead to complete recovery.
- This case underscores the importance of thorough investigation for non-malignant causes of adrenal masses.