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Persistence of histoplasma in adrenals 7 years after antifungal therapy

Deepak Kothari1, Shweta Chopra, Minakshi Bhardwaj

  • 1Endocrinology Unit, Dr. RML Hospital, Delhi, India.

Indian Journal of Endocrinology and Metabolism
|July 23, 2013
PubMed

Insights

Adrenal histoplasmosis, a rare cause of adrenal insufficiency, may require prolonged antifungal treatment. A case study revealed persistent infection 7 years after initial therapy, suggesting longer treatment durations are needed.

Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Mycology

Background:

  • Adrenal histoplasmosis is an infrequent cause of adrenal insufficiency.
  • Current treatment guidelines for adrenal histoplasmosis recommend antifungal therapy for 6 months to 2 years.
  • The optimal duration of treatment remains unclear.

Observation:

  • A rare case of adrenal histoplasmosis is presented.
  • The patient received initial antifungal treatment with itraconazole for 9 months.
  • Adrenal biopsy 7 years post-treatment showed persistent Histoplasma organisms.

Findings:

  • Histoplasma persistence in adrenal tissue can occur despite standard antifungal treatment durations.
  • This case highlights the potential for prolonged or relapsing adrenal histoplasmosis.
  • Current treatment durations may be insufficient for complete eradication in some cases.

Implications:

  • Prolonged antifungal therapy may be necessary for adrenal histoplasmosis.
  • Regular monitoring of adrenal morphology and histology is crucial for patients with adrenal histoplasmosis.
  • Further research is needed to establish optimal treatment durations and monitoring protocols.
Keywords:
Addison's diseaseantifungal therapyhistoplasma

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