Jagadish Ishitha, Chen William J, Agarwal Reema, Shoela Ramy
Department of Diagnostic Radiology, Saint Louis University School of Medicine, Saint Louis, USA.
Cureus. 2022 Oct 23;14(10):e30614. doi: 10.7759/cureus.30614. eCollection 2022 Oct.
Histoplasmosis is a chronic, infectious disease caused by the environmental fungus , primarily affecting the respiratory system. In immunocompromised patients, histoplasmosis can become severely complicated due to dissemination into various other organ systems. Adrenal insufficiency is an uncommon complication of disseminated histoplasmosis, as its manifestation requires necrotizing granulomatous inflammation of both adrenal glands. We describe a rare case of delayed histoplasmosis in the bilateral adrenal glands and liver of an immunocompromised patient with development of symptoms at 21 years after liver transplant and nine years after renal transplant. In addition, this patient presented with secondary adrenal insufficiency due to long-term use of corticosteroids rather than the typical primary adrenal insufficiency seen in histoplasmosis with adrenal involvement.
组织胞浆菌病是一种由环境真菌引起的慢性传染病，主要影响呼吸系统。在免疫功能低下的患者中，组织胞浆菌病可因扩散至其他各种器官系统而变得严重复杂。肾上腺功能不全是播散性组织胞浆菌病的一种罕见并发症，因为其表现需要双侧肾上腺发生坏死性肉芽肿性炎症。我们描述了一例免疫功能低下患者双侧肾上腺和肝脏发生迟发性组织胞浆菌病的罕见病例，该患者在肝移植后21年和肾移植后9年出现症状。此外，该患者因长期使用皮质类固醇而出现继发性肾上腺功能不全，而非组织胞浆菌病累及肾上腺时常见的典型原发性肾上腺功能不全。
