title: [Addison crisis due to bilateral adrenal gland histoplasmosis].
abstract: A 44-year-old man was admitted with symptoms compatible with Addison crisis. Abdominal computer tomography revealed extensive bilateral adrenal abscesses. Histoplasma capsulatum was cultured from a needle aspirate. The patient was HIV-seronegative and had no underlying malignancy. He may have acquired the infection during several stays in endemic areas in the United States, South America and Asia. The case was also remarkable for moderate brain atrophy, thrombosis of the portal and splenic veins and liver cirrhosis caused by alpha-1-antitrypsin deficiency (phenotype MZ). The patient recovered fully under substitution of adrenal hormones and antifungal treatment. He received intravenous amphotericin B (75 mg q24h) for 10 days, followed subsequently by oral treatment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the inflammatory adrenal lesions.
authors.affiliation: Medizinische Klinik, Kantonsspital Zug.
authors.forename: D M
authors.initials: DM
authors.lastname: Münger
authors.forename: J
authors.initials: J
authors.lastname: Gasser
authors.forename: G
authors.initials: G
authors.lastname: Schär
authors.forename: R
authors.initials: R
authors.lastname: Flury
authors.forename: M
authors.initials: M
authors.lastname: Vogt
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology; D000208:Acute Disease; D000224:Addison Disease / Q000209:etiology*; D000307:Adrenal Gland Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology*; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D006660:Histoplasmosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008297:Male; D014057:Tomography, X-Ray Computed; D019896:alpha 1-Antitrypsin Deficiency
chemical_list: D017964:Itraconazole; D000666:Amphotericin B
vernacular_title: Addisonkrise infolge beidseitiger Nebennierenhistoplasmose.