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Case Report of Disseminated Adrenal Histoplasmosis and Secondary Adrenal Insufficiency

Ishitha Jagadish1, William J Chen1, Reema Agarwal1

  • 1Department of Diagnostic Radiology, Saint Louis University School of Medicine, Saint Louis, USA.

Cureus
|November 25, 2022
PubMed

Insights

A rare case of disseminated histoplasmosis (a fungal infection) occurred in the adrenal glands and liver of an immunocompromised patient 21 years post-liver transplant. This led to secondary adrenal insufficiency, differing from typical presentations.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Transplant Medicine

Background:

  • Histoplasmosis, caused by H. capsulatum, typically affects the respiratory system.
  • Disseminated histoplasmosis can complicate immunocompromised individuals, affecting multiple organ systems.
  • Adrenal insufficiency is an uncommon but severe complication, requiring bilateral adrenal gland involvement.

Observation:

  • A rare case of delayed disseminated histoplasmosis involving bilateral adrenal glands and liver is presented.
  • The patient was immunocompromised, with symptoms manifesting 21 years after liver transplant and 9 years after renal transplant.
  • The patient developed secondary adrenal insufficiency due to long-term corticosteroid use.

Findings:

  • The case highlights a delayed presentation of histoplasmosis in transplant recipients.
  • It underscores the possibility of adrenal involvement even years after initial immunosuppression.
  • The development of secondary, rather than primary, adrenal insufficiency is a notable deviation from typical patterns.

Implications:

  • This case expands the understanding of histoplasmosis's potential long-term complications in immunocompromised hosts.
  • It emphasizes the importance of considering fungal infections in the differential diagnosis of adrenal insufficiency in transplant patients.
  • Clinicians should maintain vigilance for disseminated histoplasmosis, even with atypical presentations and delayed onset, in this population.
Keywords:
adrenal histoplasmosisdisseminated histoplasmosishistoplasma capsulatumimmunocompromisedsecondary adrenal insufficiency

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