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Subramanian M, Mehta A, Jha P. Unusual Presentation of Disseminated Histoplasmosis in an Immunocompetent Host. Cureus 2023; 15:e44170. [PMID: 37753008 PMCID: PMC10519440 DOI: 10.7759/cureus.44170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Histoplasmosis, a fungal infection caused by the inhalation of Histoplasma capsulatum conidia spores, has been shown to cause disseminated disease in immunocompromised individuals. Disseminated histoplasmosis manifests as multi-system involvement including pulmonary and/or neurological disease. Imaging findings, such as pulmonary focal infiltrates, cavitary nodules, mediastinal, and hilar lymphadenopathy, are common. Here, we report a rare case of disseminated histoplasmosis in a 58-year-old immunocompetent male with no occupational exposure. This patient presented with primary adrenal insufficiency, and a subsequent CT-guided biopsy of the adrenal gland was performed and revealed numerous spores containing Histoplasma capsulatum. This patient also suffered from numerous pulmonary and neurological derangements, which are likely sequelae of the disseminated fungal infection. Ultimately, the patient succumbed to their illness and died. Preventing such outcomes relies on early detection and prompt management, which are crucial in treating disseminated histoplasmosis. Increased awareness of atypical presentations can enhance patient outcomes and alleviate the impact of this severe fungal infection. This case not only underscores the importance of considering disseminated histoplasmosis in an immunocompetent patient presenting with unexplained weight loss and adrenal insufficiency but also contributes to the limited literature on disseminated histoplasmosis in immunocompetent individuals.
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Affiliation(s)
| | - Ashin Mehta
- Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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Bhatti H, Batbileg E, De S, Friedman G, Antony S. Acute Colonic Perforation with Septic Shock Secondary to Disseminated Histoplasmosis in an Autologous Bone Marrow Transplant Recipient. Infect Drug Resist 2023; 16:3029-3034. [PMID: 37215300 PMCID: PMC10199683 DOI: 10.2147/idr.s402228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Histoplasma capsulatum is an opportunistic pathogen which can lead to a wide variety of clinical presentations in the immunocompromised host. Post-transplant histoplasmosis in hematopoietic cell transplant recipients is exceedingly rare, with an incidence of <1%. We present a case of acute caecal perforation resulting from disseminated histoplasmosis in a patient who had undergone autologous bone marrow transplant for plasma cell dyscrasia. This is a 71-year-old patient who initially presented due to progressive weakness associated with shortness of breath.
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Affiliation(s)
- Harsimrandeep Bhatti
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Enkhbileg Batbileg
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Srijisnu De
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Glen Friedman
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Suresh Antony
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
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Grover SB, Grover H, Antil N, Patra S, Sen MK, Nair D. Imaging Approach to Pulmonary Infections in the Immunocompromised Patient. Indian J Radiol Imaging 2022; 32:81-112. [PMID: 35722641 PMCID: PMC9205686 DOI: 10.1055/s-0042-1743418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi (Former and source of this work)
- Department of Radiology and Imaging, Sharda School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India (Current)
| | - Hemal Grover
- Department of Radiology and Imaging, Icahn School of Medicine at Mount Sinai West, New York, New York, United States
| | - Neha Antil
- Department of Radiology and Imaging, Stanford University, California, United States
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manas Kamal Sen
- Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepthi Nair
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Iyer H, Anand A, Sryma PB, Gupta K, Naranje P, Damle N, Mittal S, Madan NK, Mohan A, Hadda V, Tiwari P, Guleria R, Madan K. Mediastinal lymphadenopathy: a practical approach. Expert Rev Respir Med 2021; 15:1317-1334. [PMID: 33888038 DOI: 10.1080/17476348.2021.1920404] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Mediastinal lymphadenopathy is secondary to various benign and malignant etiologies. There is a variation in the underlying cause in different demographic settings. The initial clue to the presence of enlarged mediastinal lymph nodes is through thoracic imaging modalities. Malignancy (Lung cancer, lymphoma, and extrathoracic cancer) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. For a confident diagnosis, the clinician must choose from several available options and integrate the clinical, radiological, and pathology findings. An accurate diagnosis is necessary for optimal management.Areas covered: We performed a search of the PUBMED database to identify relevant articles on the causes, imaging modalities, and interventional modalities to diagnose these conditions. We discuss a practical approach toward the evaluation of a patient with mediastinal lymphadenopathy.Expert opinion: Mediastinal lymphadenopathy is a commonly encountered clinical problem. Treating physicians need to be aware of the clinico-radiological manifestations of the common diagnostic entities. Selecting an appropriate tissue diagnosis modality is crucial, with an intent to use the least invasive technique with good diagnostic yield. Endosonographic modalities (EBUS-TBNA, EUS-FNA, and EUS-B-FNA) have emerged as the cornerstone to most patients' diagnosis. An accurate diagnosis translates into favorable treatment outcomes.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhishek Anand
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kapatia G, Saha A, Rohilla M, Gupta P, Gupta N, Srinivasan R, Rajwanshi A, Dey P. Clinical and Morphological Spectrum of Histoplasmosis on Cytology Along with the Review of Literature. Acta Cytol 2020; 64:532-538. [PMID: 32702707 DOI: 10.1159/000509151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/30/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to study the clinical and morphological spectrum of histoplasmosis diagnosed by fine needle aspiration cytology (FNAC). STUDY DESIGN A total of 17 patients diagnosed with histoplasmosis on FNAC were studied over a period of 5 years. The cytology smears were studied and analysed for the cytomorphological spectrum of histoplasmosis. RESULTS Among the 17 patients studied, the mean age was 51.3 years (range 6-84 years). Male-to-female ratio was 3.25:1 with 4 females and 13 males. The frequent sites of involvement were the lung (5), lymph node (4), adrenal gland (4), and skin (4). The most common cytological patterns were histiocytic collection, followed by granulomas and multinucleated giant cells. Necrosis was noted in only 4 cases. CONCLUSION Fine needle aspiration is a highly accurate, rapid, and cheap technique for the diagnosis of histoplasmosis due to its distinct morphological features.
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Affiliation(s)
- Gargi Kapatia
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashmita Saha
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,
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Bansal RK, Choudhary NS, Patle SK, Agarwal A, Kaur G, Sarin H, Puri R. Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: A single-center experience of 52 cases. Indian J Gastroenterol 2018; 37:108-112. [PMID: 29594708 DOI: 10.1007/s12664-018-0825-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of adrenals is needed in patients with pyrexia of unknown origin (PUO) and adrenal enlargement in absence of other diagnostic clues. Adrenals are easily accessible by endoscopic ultrasound (EUS) due to proximity; however, there is no systemic study available on FNA of adrenals in patients with PUO. The aim of this study was to evaluate the diagnostic yield and safety of EUS-FNA of enlarged adrenal in patients with PUO. METHODS Data was analyzed from October 2010 to September 2016 at a single tertiary care center in northern India. EUS-FNA of enlarged adrenals was done in 52 patients for the etiological diagnosis of PUO in whom a definitive diagnosis could not be made with other means. RESULTS The mean age was 48±14 years; 36 were males and 16 were females. EUS-FNA was done from the left adrenal in 50 patients and from the right sample in 2 patients. A technical success was achieved in 100% cases. The 19-G needle was used in the majority (75%) to the presence of necrotic areas in adrenals; median numbers of passes were 2. The cytopathological diagnoses were tuberculosis (n = 36), histoplasmosis (n = 13), lymphoma (n = 2), and metastasis from undiagnosed neuroendocrine tumor of lung (n = 1). Thus, a diagnosis could be made in 52/52 (100%) patients. None of the patients had any procedure-related complications. CONCLUSIONS EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.
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Affiliation(s)
- Rinkesh K Bansal
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Narendra S Choudhary
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Saurabh K Patle
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Amit Agarwal
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Gagandeep Kaur
- Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Haimanti Sarin
- Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India.
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Grover S, Selhi PK, Sood N, Sood R, Kaur H. "Polka Dot Macrophages" on cytology of bilateral adrenal masses-Nailing disseminated histoplasmosis. Diagn Cytopathol 2017; 45:943-946. [PMID: 28548709 DOI: 10.1002/dc.23758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/20/2017] [Accepted: 05/08/2017] [Indexed: 11/06/2022]
Abstract
Histoplasma capsulatum is a saprophytic fungus that in immunocompetent individuals causes self-limited pulmonary infection; however, in immunosuppressed patients involvement of the reticuloendothelial system, alimentary tract, urinary tract, and central nervous system is fairly common. Rarely patients present with bilateral adrenal masses which mimic tuberculosis and metastasis on radiology because of associated central necrosis. Ultrasound guided FNAC aided by special stains like Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) may help in early diagnosis in such dubious cases. Polka dot macrophages were the clue to diagnosis of histoplasmosis on toluidine blue rapid staining, Hematoxylin & Eosin, and Pap stained smears. We report this case because of its rarity, diagnostic difficulty on radiology, and rapidity of diagnosis by FNA due of its characteristic cytomorphology.
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Affiliation(s)
- Sumit Grover
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Ridhi Sood
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
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Cutaneous Manifestation of Underlying Disseminated Histoplasmosis in an Immunocompetent Host of Nonendemic Area with Reversible CD4 Cell Depletion and its Recovery on Antifungal Therapy. Mycopathologia 2015; 180:223-7. [PMID: 25894510 DOI: 10.1007/s11046-015-9892-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
We present the case of an 18-year-old male patient admitted with complaints of fever and rapid weight loss since 3 months. Patient had multiple umbilicated papular to nodular lesions over chin and forehead region. Complete blood count revealed bicytopenia. An excisional biopsy of the skin lesions had revealed cutaneous histoplasmosis. On further investigations for bicytopenia, histoplasmosis had been diagnosed on bone marrow trephine biopsy. For the immune status, patient's serology against HIV was negative and his CD4 lymphocyte counts were low at 161. Patient received antifungal therapy including amphotericin B and itraconazole. He showed remarkable improvement in his general condition and blood counts. A repeat CD4 count showed normal counts, and idiopathic CD4 lymphocytopenia was excluded. Disseminated histoplasmosis presenting as cutaneous lesions in an immunocompetent host is very rare, and we are not aware of any case report in the literature where there is reversible depletion of CD4 counts following antifungal treatment in an immunocompetent host of nonendemic area.
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Ross IL, Levitt NS. Diagnosis and management of Addison's disease: insights gained from a large South African cohort. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2011.10872256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- IL Ross
- Division of Endocrinology, University of Cape Town
| | - NS Levitt
- Division of Endocrinology, University of Cape Town
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Atiee G, Kvitko-White H, Spaulding K, Johnson M. ULTRASONOGRAPHIC APPEARANCE OF HISTOPLASMOSIS IDENTIFIED IN THE SPLEEN IN 15 CATS. Vet Radiol Ultrasound 2013; 55:310-4. [DOI: 10.1111/vru.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/08/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Genna Atiee
- Department of Small Animal Clinical Sciences
| | | | | | - Mark Johnson
- Department of Veterinary Pathobiology; Texas A&M University; TX 77843
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Bons J, Moreau L, Lefebvre H. Adrenal disorders in human immunodeficiency virus (HIV) infected patients. ANNALES D'ENDOCRINOLOGIE 2013; 74:508-14. [DOI: 10.1016/j.ando.2013.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 01/14/2023]
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Kathuria S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and review. Med Mycol 2013; 51:774-8. [DOI: 10.3109/13693786.2013.777166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vyas S, Kalra N, Das PJ, Lal A, Radhika S, Bhansali A, Khandelwal N. Adrenal histoplasmosis: An unusual cause of adrenomegaly. Indian J Nephrol 2011; 21:283-5. [PMID: 22022092 PMCID: PMC3193675 DOI: 10.4103/0971-4065.78071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Histoplasmosis is a geographically restricted form of fungal infection. Adrenal involvement is seen in disseminated disease but sometimes it may be the only site of demonstrable disease. Early diagnosis and treatment may save the patient from catastrophic adrenal insufficiency. We present two patients showing bilateral adrenomegaly on ultrasonography and contrast-enhanced CT, and was diagnosed to have histoplasmosis on fine-needle aspiration cytology.
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Affiliation(s)
- S Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rana C, Krishnani N, Kumari N. Bilateral adrenal histoplasmosis in immunocompetent patients. Diagn Cytopathol 2011; 39:294-6. [PMID: 20607678 DOI: 10.1002/dc.21416] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, which commonly presents as transient pulmonary infection that usually subsides without treatment. Disseminated histoplasmosis may affect almost all systems, including the reticuloendothelial system, lungs, gastrointestinal tract, renal tract, central nervous system, bone marrow, and adrenal glands. Adrenal gland is frequently involved in disseminated histoplasmosis but commonly present as unilateral mass; bilateral involvement is rare. It is also rare in immunocompetent hosts and only few cases have been reported in past. We report four cases of adrenal histoplasmosis with bilateral involvement. These cases were initially diagnosed cytopathologically on fine needle aspirations performed on adrenal glands. All these patients were immunocompetent and two of them also had associated adrenal insufficiency. Diagnosis of adrenal histoplasmosis can be easily made on fine needle aspiration cytology. Adrenal histoplasmosis can occur in immunocompetent individuals and should be considered in differential diagnosis of bilateral adrenal masses in immunocompetent individuals.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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Jaiswal S, Vij M, Chand G, Misra R, Pandey R. Diagnosis of adrenal histoplasmosis by fine needle aspiration cytology: an analysis based on five cases. Cytopathology 2010; 22:323-8. [PMID: 20825451 DOI: 10.1111/j.1365-2303.2010.00803.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rappo U, Beitler J, Faulhaber J, Firoz B, Henning J, Thomas K, Maslow M, Goldfarb D, Horowitz H. Expanding the horizons of histoplasmosis: disseminated histoplasmosis in a renal transplant patient after a trip to Bangladesh. Transpl Infect Dis 2010; 12:155-60. [DOI: 10.1111/j.1399-3062.2009.00466.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kok J, Chen SCA, Anderson L, Berglund L, Sleiman S, Moss A, Bourke M, Fulcher D, Gilroy N. Protein-losing enteropathy and hypogammaglobulinaemia as first manifestations of disseminated histoplasmosis coincident with Nocardia infection. J Med Microbiol 2010; 59:610-613. [PMID: 20133412 DOI: 10.1099/jmm.0.017194-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Disseminated histoplasmosis and nocardiosis typically affect immunocompromised hosts. We report a case of gastrointestinal and adrenal histoplasmosis, presenting as protein-losing enteropathy and hypogammaglobulinaemia, coincident with Nocardia infection, in a HIV-negative patient in whom a specific immunological defect could not be identified. Clinicians in areas of non-endemicity should be vigilant for rare manifestations of histoplasmosis.
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Affiliation(s)
- Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW 2145, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW 2145, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Lyndal Anderson
- Department of Anatomical Pathology and Cytology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Lucinda Berglund
- Department of Immunology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Sue Sleiman
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Alan Moss
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Michael Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - David Fulcher
- Department of Immunology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia
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[Diagnosis of fungal pneumonia in the thoracic CT]. ACTA ACUST UNITED AC 2008; 56:207-18. [PMID: 19294867 DOI: 10.1016/j.rontge.2008.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The importance of fungal infection of the lung in immunocompromised patients has increased substantially during the last decades. Numerically the most patients are those with neutropenia, e.g., patients with malignancies or solid organ and stem cell transplantation, chemotherapy, corticosteroid use and HIV infection. Although fungal infections can occur in immunocompetent patients, their frequency in this population is rare. The clinical symptoms such as fever accompanied with non-productive cough are unspecific. In some patients progression to hypoxemia and dyspnea may occur rapidly. In spite of improved antifungal therapy morbidity and mortality of these infections are still high. Therefore an early and non-invasive diagnosis is very important. That is why CT and even better High-Resolution-CT (HR-CT) is a very important modality in examining immunocompromised patients with a probability of fungal infection. CT is everywhere available and, as a non-invasive method, able to give the relevant diagnose efficiently. This paper should give an overview about the radiologic findings and possible differential diagnosis of diverse pulmonary fungal infections in CT. Pneumonias caused by Aspergillus, Cryptococcus, Candida, Histoplasma, Mucor and Geotrichum capitatum are illustrated.
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Benevides CFL, Durães RO, Aquino B, Schiavon LDL, Narciso-Schiavon JL, Buzzoleti FDC. Bilateral adrenal histoplasmosis in an immunocompetent man. Rev Soc Bras Med Trop 2007; 40:230-3. [PMID: 17568895 DOI: 10.1590/s0037-86822007000200017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 01/17/2007] [Indexed: 11/22/2022] Open
Abstract
Histoplasmosis is a fungal disease that is endemic in Brazil. It may present as chronic pulmonary infection or in disseminated form. Disseminated histoplasmosis frequently affects the adrenal gland; however, unilateral involvement in immunosuppressed patients is the usual presentation. We report a case of an elderly immunocompetent male with history of weight loss, fever and bilateral adrenal mass who was successfully treated with itraconazole.
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Paolo WF, Nosanchuk JD. Adrenal infections. Int J Infect Dis 2006; 10:343-53. [PMID: 16483815 PMCID: PMC7110804 DOI: 10.1016/j.ijid.2005.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 08/01/2005] [Accepted: 08/08/2005] [Indexed: 11/18/2022] Open
Abstract
Adrenal infections are an important but under-recognized clinical entity. The adrenal gland can be infected by a myriad of pathogens including fungi, viruses, parasites, and bacteria. Infection can directly or indirectly cause tissue damage and alteration in endocrine function. Direct damage occurs via microbial replication and local production of toxic compounds, such as endotoxins. Indirect damage results from alterations in the regulation of a host's immunologic and endocrine mediators in response to damage by a microbe at a distant site. Variations in pathogen tropism, adrenal anatomy, and host immune integrity contribute to the progression of active disease and discernable adrenal dysfunction. Early recognition and intervention in the case of adrenal infection can significantly improve outcome, demonstrating the need for increased clinical suspicion in the appropriate clinical setting.
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