Bilateral adrenal histoplasmosis, a case report
Keywords:
adrenal incidentaloma, adrenal histoplasmosis, Histoplasma capsulatumAbstract
Introduction: Bilateral adrenal lesions encompass a variable spectrum of etiologies. Bilateral adrenal masses are relatively uncommon and present with varied clinical manifestations, while some cases may be asymptomatic and others may show severe systemic features. Adrenal involvement by Histoplasmosis is not frequently observed, especially in immunocompetent subjects.
Objective: To describe the case of an immunocompetent patient diagnosed with bilateral adrenal histoplasmosis.
Case presentation: A 58-year-old male patient from an urban setting with a personal history of essential arterial hypertension for the past 15 years, for which he is on a health and dietary regimen. He also has a history of being a moderate smoker and having worked for approximately 20 years in an underground warehouse. The patient was admitted to the Endocrinology Department of the Hermanos Ameijeiras Hospital, where he was referred from his province due to bilateral adrenal masses. The diagnosis of bilateral adrenal histoplasmosis was confirmed. The patient is currently receiving itraconazole and is being monitored in the endocrinology outpatient clinic, with adrenal function replacement, and is progressing satisfactorily.
Conclusions: Histoplasmosis presents a diagnostic challenge due to its varied clinical manifestations and its potential to mimic other diseases. Adrenal histoplasmosis is uncommon, even in immunocompetent patients, and should be considered in the differential diagnosis of bilateral adrenal incidentaloma. Early diagnosis and immediate initiation of antifungal treatment are crucial to prevent serious complications and mortality.
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Copyright (c) 2025 Sergio Enrique Zayas Puig, Noraika Domínguez Pacheco, Marisela Nuez Vilar, Idania María Reyes Martínez
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