Adrenal histoplasmosis: a case series and review of the literature (2011)

[WillowJ]

Southeast Asian J Trop Med Public Health. ;42(4):920-5.

Adrenal histoplasmosis: a case series and review of the literature.

Larbcharoensub N, Boonsakan P, Aroonroch R, Rochanawutanon M, Nitiyanant P, Phongkitkarun S, Poonvutikul S, Watcharananan SP, Ngarmukos C.

Adrenal histoplasmosis is an uncommon mycotic disease typically caused by Histoplasma capsulatum.

The objective was to determine the clinicopathological findings in adrenal histoplasmosis. Pathological records were searched from the database at the Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University from 1993 to 2008 for cases of adrenal histoplasmosis. The keywords were "histoplasmosis" and "adrenal gland".

Adrenal histoplasmosis was diagnosed by histopathology and Gomori-Grocott methenamine silver staining. Histoplasma capsulatum was confirmed by tissue culture and/or serology. The authors report seven cases of adrenal histoplasmosis in immunocompetent patients.

The mean age at diagnosis was 67 years. All patients presented as chronic fatigue syndrome. The onset of symptoms ranged from one to three months.

Addison's disease was found in adrenal histoplasmosis in one case (14.3%). The computed tomography revealed adrenal nodules measuring 1.2 to 7.8 cm in diameter. The histopathology showed granulomatous inflammation with caseous necrosis.

Culture of adrenal tissue from two patients revealed Histoplasma capsulatum. Serum Histoplasma antibodies were positive in four cases. A cure was accomplished in 6 out of 7 cases (85.7%). The patients were followed up for 2.5 to 16.5 years.

http://www.ncbi.nlm.nih.gov/pubmed/22299474

free full:
http://www.tm.mahidol.ac.th/seameo/2011-42-4/18-5007.pdf

 

[WillowJ]

All patients were Thai immunocompetent individuals, who presented with chronic fatigue, weight loss, anorexia, and fever.

Many pathogens are known to affect the adrenal gland in both immunocompetent and immunocompromised individuals.

Patients with adrenal histoplasmosis have many of the same symptoms as those with the chronic fatigue syndrome. Adrenal histoplasmosis may diminish intracellular perforin by depressing T lymphocyte and natural killer cell function, causing chronic fatigue (Zhouet al, 2001; Maher et al, 2005).

 

[alex3619]

Thank you for this @WillowJ, I think this might be an exciting find. I have yet to read the full paper.

http://en.wikipedia.org/wiki/Mycosis

Mycosis is a propensity for fungal infections, and may be associated with histoplasmosis. I have problems along those lines, and I was born not far from where the study was done. Hmmm, something to test? However the likelihood of a positive is under 1% even in Thailand from what I gather.

 

[alex3619]

Its interesting that they often find the problem on autopsy. We might like to make a list of possible pathogens like this at some point.