Disseminated cryptococcosis causes adrenal insufficiency in an immunocompetent individual.
Disseminated cryptococcosis infection occurs mainly in the immunocompromised host. There are only a few reports describing disseminated cryptococcosis in immunocompetent patients. Here, we describe the case of a 46-year-old healthy man who presented with primary adrenal insufficiency with hyponatremia, hyperkalemia and skin pigmentation. Contrast-enhanced adrenal computed tomography (CT) revealed bilaterally enlarged adrenal glands without enhancement. CT-guided percutaneous adrenal gland biopsy showed caseous-like necrosis and embedded cryptococcosis. The serum cryptococcal antigen titer was 1:512. After ten months of fluconazole treatment, the serum cryptococcal antigen titer remained elevated at 1:256 and contrast-enhanced adrenal magnetic resonance imaging revealed continued enlargement of bilateral adrenal glands without enhancement. The patient is currently on a therapeutic regimen of prednisolone, fludrocortisone and fluconazole and is scheduled for regular outpatient follow-up.
Hung
Zui-Sheng
ZS
Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Lai
Yu-Hsien
YH
Hsu
Yung-Hsiang
YH
Wang
Chih-Hsien
CH
Fang
Te-Chao
TC
Hsu
Bang-Gee
BG
D000224:Addison Disease / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology*; D003453:Cryptococcosis / Q000150:complications* / Q000276:immunology*; D006801:Humans; D007121:Immunocompetence / Q000276:immunology*; D008297:Male; D008875:Middle Aged