title: Histoplasmosis presenting with progressively worsening backache--a case report.
abstract: BACKGROUND
  Bilateral adrenal enlargement is often the result of disseminated malignant disease, and this diagnosis is particularly likely in a patient with severe weight loss. We describe a case with bilateral adrenal enlargement presenting with progressively worsening backache as a prominent symptom.
  
  
  METHODS
  A 55-year-old man presented with intermittent low back pain which was progressively worsening, fever, anorexia, low back pain and a 10-kg weight loss. He had underlying diabetes mellitus and ischaemic heart disease. He gave a history of travel to caves for worship. Clinically, the most significant findings included nodular lesions in the anterior fauces and left palatoglossal region. Computed tomographic scan revealed bilateral adrenal masses. Biopsies were taken from the palatal nodules, which revealed histiocytes with numerous histoplasma organisms.
  
  
  METHODS
  He was commenced on itraconazole 200 mg daily for a period of 9 months. There was a dramatic initial response with settling of his fever and this was followed by subjective improvement in his well-being.
  
  
  RESULTS
  He is presently on follow-up and has completed 9 months of itraconazole therapy with resolution of all his symptoms and has gained about 10 kg of weight.
authors.affiliation: Department of Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: S R
authors.initials: SR
authors.lastname: Lachmanan
authors.forename: O
authors.initials: O
authors.lastname: Haniza
authors.forename: A N
authors.initials: AN
authors.lastname: Hisham
authors.forename: J
authors.initials: J
authors.lastname: Subramaniam
authors.forename: I
authors.initials: I
authors.lastname: Merican
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D006660:Histoplasmosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole