Jayathilake Wanasinghe Arachchilage Praneeth Prabash, Kumarihamy Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini, Ralapanawa Dissanayake Mudiyanselage Priyantha Udaya Kumara, Jayalath Widana Arachchilage Thilak Ananda
University Medical Unit, Teaching Hospital Peradeniya, Kandy, Sri Lanka.
Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Case Rep Med. 2020 Mar 17;2020:8506746. doi: 10.1155/2020/8506746. eCollection 2020.
Histoplasmosis is caused by , and commonly it causes an asymptomatic illness. Although is the commonest organism to infect adrenal glands, disseminated histoplasmosis in an immune-competent host leading to adrenal insufficiency is rare in current literature. Here, we report a case of possible disseminated histoplasmosis leading to adrenal crisis in a young Asian immunocompetent male. A 42-year-old Sri Lankan male with noninsulin-dependent diabetes mellitus presented with constitutional symptoms and feverishness for three weeks' duration. He was found to have hepatosplenomegaly with bilateral adrenal masses and pancytopenia. One week later, he developed severe vomiting and hemodynamic collapse and was found to have suppressed adrenal functions. Ultrasound-guided biopsy of adrenals showed fungal spores morphologically similar to . He was started on oral itraconazole and adrenal replacement therapy. He improved symptomatically with treatment and currently is on regular clinic follow-up with a plan to continue antifungal therapy for at least one year to prevent a relapse. Fungal infections, especially histoplasmosis, need to be considered in all immunocompetent patients with compatible history and bilateral adrenal masses. Adrenal insufficiency needs to be promptly diagnosed and treated to prevent Addisonian crisis in these patients.
组织胞浆菌病由[此处原文缺失病原体名称]引起，通常导致无症状疾病。尽管[此处原文缺失病原体名称]是最常见的感染肾上腺的病原体，但在当前文献中，免疫功能正常的宿主发生播散性组织胞浆菌病导致肾上腺功能不全的情况很少见。在此，我们报告一例年轻的亚洲免疫功能正常男性可能因播散性组织胞浆菌病导致肾上腺危象的病例。一名42岁患有非胰岛素依赖型糖尿病的斯里兰卡男性出现全身症状和发热持续三周。发现他有肝脾肿大、双侧肾上腺肿块和全血细胞减少。一周后，他出现严重呕吐和血流动力学崩溃，发现肾上腺功能受到抑制。肾上腺超声引导下活检显示真菌孢子在形态上与[此处原文缺失病原体名称]相似。他开始接受口服伊曲康唑和肾上腺替代治疗。经治疗后症状有所改善，目前正在定期门诊随访，计划继续抗真菌治疗至少一年以预防复发。对于所有有相关病史且有双侧肾上腺肿块的免疫功能正常患者，都需要考虑真菌感染，尤其是组织胞浆菌病。需要及时诊断和治疗肾上腺功能不全，以预防这些患者发生艾迪生病危象。
