Disseminated histoplasmosis diagnosed by computed tomography directed needle biopsy of an adrenal mass

Disseminated histoplasmosis was diagnosed by a computed tomographic (CT) directed needle biopsy of an adrenal mass. A 53-year-old man presented with a nonproductive cough, bilateral flank discomfort, and constitutional symptoms. Physical exam revealed mild hepatomegaly and tenderness. Chest radiograph revealed two destructive bone lesions. An abdominal CT scan demonstrated bilateral adrenal masses. Needle biopsy of the left adrenal mass revealed histoplasmosis. A rib resection or exploratory laparotomy was avoided. He has been completely free of evidence of disease for 6 months following completion of antibiotic therapy.