Disseminated histoplasmosis presenting as adrenal insufficiency: A case report

This report aims to highlight rarity of disseminated histoplasmosis (DH) presenting as adrenal insufficiency and the need for considering it in the differential diagnosis, even in non-endemic areas. A case is presented of a 69-year-old male patient with a background of hypertension and diabetes mellitus, with a persistent fever, significant loss of weight, and general weakness. Imaging studies showed adrenal masses in both adrenal glands, and laboratory tests showed hyperkalemia and hyponatremia. Hormonal tests confirmed the diagnosis of adrenal insufficiency. CT-guided adrenal biopsy confirmed the diagnosis of histoplasmosis. The patient received a 14-day course of Amphotericin B, followed by oral Itraconazole and glucocorticoid substitution therapy, with improvement in adrenal function over a period of time.