title: Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report.
abstract: BACKGROUND
  Cryptococcus species usually affect the central nervous system and lungs in immunocompromised hosts. Although the adrenal glands can be involved in disseminated cryptococcosis, primary adrenal insufficiency caused by the fungal infection is uncommon.
  
  
  METHODS
  We present a case of primary adrenal insufficiency with bilateral adrenal masses and liver invasion in a 43-year-old man with mild type 2 diabetes mellitus. Cryptococcosis was diagnosed by fine-needle aspiration biopsy of the liver mass. The serum cryptococcal antigen titer was elevated to 1:256. After 6 months of antifungal therapy with fluconazole and amphotericin B, the size of the liver mass was decreased, but no significant changes were observed in the bilateral adrenal masses and the serum cryptococcal antigen titer remained elevated at 1:128. To control the cryptococcosis, a laparoscopic left adrenalectomy was performed, followed by antifungal therapy. After the unilateral adrenalectomy, the size of the remaining right adrenal mass was reduced and the serum cryptococcal antigen titer declined to 1:4.
  
  
  CONCLUSIONS
  This is the first report describing adrenal cryptococcosis with adrenal insufficiency and liver invasion without central nervous system involvement. Adrenal cryptococcosis should be considered in the differential diagnosis for patients with bilateral adrenal masses with primary adrenal deficiency. Unilateral adrenalectomy was quite effective in controlling the cryptococcosis in this case. Even in patients with bilateral adrenal cryptococcosis, unilateral adrenalectomy should be an option for treatment of disseminated cryptococcosis.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Hisaya
authors.initials: H
authors.lastname: Kawate
authors.forename: Yuka
authors.initials: Y
authors.lastname: Okishige
authors.forename: Ichiro
authors.initials: I
authors.lastname: Abe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Adachi
authors.forename: Keizo
authors.initials: K
authors.lastname: Ohnaka
authors.forename: Naoichi
authors.initials: N
authors.lastname: Satoh
authors.forename: Junichi
authors.initials: J
authors.lastname: Inokuchi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Tatsugami
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nomura
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000311:Adrenal Glands / Q000382:microbiology*; D000315:Adrenalectomy; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D000946:Antigens, Fungal / Q000097:blood; D044963:Biopsy, Fine-Needle; D003453:Cryptococcosis / Q000188:drug therapy* / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008107:Liver Diseases / Q000188:drug therapy*; D008297:Male; D008853:Microscopy; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal