Adrenal insufficiency resulting from Histoplasmosis infiltration in an immunocompetent patient

Shahar MA¹, Norasyikin AW ², Aini AbAziz ³, Ahmad Marzuki O ¹, Mohd Rusly NA ⁴, Nor Azmi K ²

¹ Kulliyyah of Medicine, International Islamic University Malaysia, ²  Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, ³ Department of Molecular Imaging and Nuclear Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, and ⁴ Hospital Angkatan Tentera Tuanku Mizan, Malaysia

ABSTRACT

Histoplasmosis usually affects immunocompromised patients. Histoplasmosis infiltration to the adrenal in an immunocompetent host is rare, more so those who presented with adrenal insufficiency. We report a case of 54-year-old previously fit and healthy man who presented with chronic headache of two months duration that was associated with loss of appetite and weight-loss. He had hypotension, hyponatremia, relative hyperkalemia with morning cortisol of 160 nmol/L. Computed tomography of the adrenals showed bilateral enlarged adrenal glands and biopsy confirmed histoplasmosis infiltration. Treatment successfully ameliorate symptoms of hypocortisolism. This case illustrates that immunocompetent patient is still susceptible to adrenal histoplasmosis resulting in adrenal insufficiency.

Keywords: Adrenal insufficiency, histoplasmosis, immunocompetent, adrenal masses

Correspondence author: Norasykin A.WAHAB, Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia

Tel : +60129810882 (Mobile).

Fax: +603 91737829

E mail: Naw8282kt@gmail.com

Brunei Int Med J. 2015; 11 (5): 261-264