title: Adrenal cryptococcosis in an immunosuppressed patient showing intensely increased metabolic activity on18F-FDG PET/CT.
abstract: Disseminated cryptococcosis most commonly occurs in immunosuppressed patients and can rarely affect the adrenal glands. We report on a patient with biopsy proven bilateral adrenal cryptococcosis resulting in primary adrenal insufficiency, which was evaluated with whole-body positron emission tomography/computed tomography scan using18F-FDG. Both enlarged adrenal glands presented intensely increased18F-FDG activity in the periphery, while central necrotic regions were photopenic. Although diagnosis was established by adrenal gland biopsy,18F-FDG positron emission tomography/computed tomography scan can significantly contribute to the assessment of disease activity and monitoring of treatment response. Furthermore, fungal infections should always be considered when encountering hypermetabolic adrenal masses, especially in the setting of immunodeficient patients.
authors.affiliation: Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, 20892, USA.
authors.forename: Georgios Z
authors.initials: GZ
authors.lastname: Papadakis
authors.affiliation: Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Holland
authors.affiliation: Department of Pathology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Quezado
authors.affiliation: Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, 20892, USA. NPatronas@cc.nih.gov.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Patronas
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging*; D000328:Adult; D003453:Cryptococcosis / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D000072078:Positron Emission Tomography Computed Tomography
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; Adrenal cryptococcosis; Primary adrenal insufficiency