Hidden Histoplasmosis: Adrenal and Central Nervous System Mycosis in an Immunocompetent Patient

Histoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum. Macroconidia released from hyphae growing in the soil are inhaled into the lungs, where there is a morphologic change to the pathogenic yeast form. While most infections are either asymptomatic or subclinical, histoplasmosis can present with a wide variety of clinical syndromes ranging from pneumonia to disseminated disease in virtually any organ system. Disseminated disease is typically associated with immunosuppression, specifically T-cell-mediated immunity. Here, we present a case of disseminated histoplasmosis to the central nervous system and adrenal glands complicated by adrenal crisis mimicking metastatic cancer. This occurred without traditional risk factors for disseminated histoplasmosis or travel to classically endemic areas of histoplasmosis, stressing the importance of consideration of invasive fungal infections in light of shifting endemic regions due to climate change.