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Tuberculous Adrenal Abscess Presenting as Adrenal Insufficiency in a 4-Year-Old Boy
Shreya Sharma1, Rajesh Joshi1, Radhika Kalelkar1
1Division of Pediatric Endocrinology, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
Insights
A young boy with early adrenal insufficiency symptoms was diagnosed with a rare tuberculous adrenal abscess. Treatment involved hormone replacement and specialized multidrug-resistant tuberculosis therapy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Endocrinology
Background:
- Adrenal insufficiency in children typically raises suspicion for congenital causes due to early symptom onset.
- Tuberculosis is an uncommon cause of adrenal insufficiency, particularly in developed nations.
- Adrenal abscesses are rare, and tuberculous etiology further narrows the differential diagnosis.
Abstract:
We describe the case of a 4.8-year-old boy who presented with adrenal crisis. The advent of symptoms of adrenal insufficiency in the patient was at around 2 years of age. Congenital causes of adrenal insufficiency were considered over acquired etiologies owing to early onset of symptoms. However, on evaluation, he was found to have left adrenal abscess of tuberculous etiology. The aspirate culture grew multidrug-resistant Mycobacterium tuberculosis complex. He was initiated on glucocorticoid and mineralocorticoid replacement, along with second-line antitubercular therapy. Unique features of our case were early presentation, primary adrenal TB causing adrenal insufficiency, unilateral involvement with adrenal abscess localization, no identifiable extra-adrenal site of tubercular dissemination and resistance to first-line TB drugs.
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