title: Disseminated cryptococcosis presenting with adrenal insufficiency and meningitis: resistant to prolonged antifungal therapy but responding to bilateral adrenalectomy.
abstract: A case of disseminated cryptococcosis with features of primary adrenal insufficiency and meningitis in an immunocompetent host is presented. Despite antifungal chemotherapy, neither meningitis nor bilateral adrenal gland enlargement was improved. Aspiration biopsy of the adrenal gland revealed necrotic tissue with numerous fungi, suggesting that the adrenal glands were the focus of the persistent fungemia. Removal of bilateral adrenal glands led to improvement by making the patient more sensitive to antifungal chemotherapy.
authors.affiliation: Division of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Takeshita
authors.forename: H
authors.initials: H
authors.lastname: Nakazawa
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.forename: R
authors.initials: R
authors.lastname: Kawai
authors.forename: K
authors.initials: K
authors.lastname: Oohashi
authors.forename: Y
authors.initials: Y
authors.lastname: Shishiba
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D000315:Adrenalectomy; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents