Singh Harshita, Das Manas, Shrama Rohan, Kumar Sourav, Sindagi Sagar M, Chaudhary Neeraj, Bhat Mukul P, Pandey Aakash, Sonika Mayanglambam, Gurtoo Anil, Sarkar Kritirupa
Postgraduate Resident, Department of Medicine, Lady Hardinge Medical College, Delhi, India, Corresponding Author.
Postgraduate Resident, Department of Medicine, Lady Hardinge Medical College, Delhi, India.
J Assoc Physicians India. 2025 Mar;73(3):91-93. doi: 10.59556/japi.73.0876.
Histoplasmosis, also referred to as Darling's disease, is mainly caused by the thermally dimorphic fungus Histoplasma capsulatum. It is usually contracted by inhaling fungal spores found in soil contaminated with bat or bird droppings, often during activities like cave exploration. Although endemic in certain regions of India, such as the eastern part, and sporadically in southern and northern states, histoplasmosis can manifest with varied clinical presentations, ranging from asymptomatic to severe disseminated disease affecting multiple organs. Adrenal involvement, though relatively uncommon, can lead to adrenal insufficiency, especially in immunocompetent individuals, with bilateral adrenal enlargement being a characteristic feature in imaging studies. This report discusses the case of a 51-year-old farmer from Haryana, India, who was diagnosed with progressive disseminated histoplasmosis (PDH) resulting in primary adrenal insufficiency. Although tuberculosis or malignancy was initially suspected, imaging studies and biopsy results confirmed histoplasmosis as the root cause. This case emphasizes the necessity of including histoplasmosis in the differential diagnosis of primary adrenal insufficiency, especially in endemic areas, and highlights the importance of early detection and appropriate management of this potentially life-threatening disease.
组织胞浆菌病，也被称为达林病，主要由双态真菌荚膜组织胞浆菌引起。通常是在吸入存在于被蝙蝠或鸟类粪便污染的土壤中的真菌孢子后感染，常在洞穴探险等活动期间感染。尽管在印度某些地区（如东部地区）为地方性疾病，在南部和北部各州也有散发病例，但组织胞浆菌病可表现出多种临床症状，从无症状到影响多个器官的严重播散性疾病不等。肾上腺受累相对少见，但可导致肾上腺功能不全，尤其是在免疫功能正常的个体中，影像学研究的特征性表现是双侧肾上腺肿大。本报告讨论了一名来自印度哈里亚纳邦的51岁农民的病例，该患者被诊断为进行性播散性组织胞浆菌病（PDH）并导致原发性肾上腺功能不全。尽管最初怀疑是结核病或恶性肿瘤，但影像学研究和活检结果证实组织胞浆菌病是根本原因。该病例强调了在原发性肾上腺功能不全的鉴别诊断中纳入组织胞浆菌病的必要性，尤其是在地方性流行地区，并突出了早期发现和适当管理这种潜在危及生命疾病的重要性。
