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Hypoadrenal crisis caused by disseminated histoplasmosis
J Lee1, P H Jones, J E Trowell
1Ipswich Hospital, Suffolk, U.K.
The Journal of Infection
|September 1, 1993
Summary
Disseminated histoplasmosis can cause acute kidney injury via adrenal insufficiency. Prompt diagnosis and antifungal treatment led to recovery, but hormone replacement is still needed.
Area of Science:
- Infectious Diseases
- Nephrology
- Endocrinology
Background:
- Disseminated histoplasmosis is a serious fungal infection, particularly in immunocompromised individuals.
- Adrenal insufficiency is a potential complication, leading to electrolyte imbalances and renal dysfunction.
- Acute kidney injury (AKI) can be a presenting manifestation of adrenal insufficiency.
Observation:
- A case of disseminated histoplasmosis presenting with AKI is described.
- Abdominal ultrasound revealed bilateral adrenal gland enlargement.
- CT-guided adrenal biopsy confirmed the diagnosis.
Findings:
- The patient experienced acute renal impairment attributed to adrenal insufficiency.
- Treatment with amphotericin B and itraconazole resulted in clinical cure.
- Adrenal replacement therapy remains necessary despite clinical improvement.
Implications:
- This case highlights the importance of considering adrenal insufficiency in disseminated histoplasmosis presenting with AKI.
- Early diagnosis and comprehensive treatment are crucial for patient outcomes.
- Long-term endocrine management is often required for patients with fungal-induced adrenal insufficiency.