Rajasreepai Ramachandra Pai1, Raghesh Varot Kangath2, Immanuel Thamban3. 1. Division of Endocrinology, Department of Internal Medicine, Baylor Scott & Whit e Health/Texas A&M Health Science Center College of Medicine, Temple, Texas, USA. drrajashree.pai@gmail.com 2. Division of Infectious Diseases, Department of Internal Medicine, Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, Texas, USA. 3. Division Endocrinology and Metabolism, Central Texas Veteran's Health Care System, Temple, Texas, USA.
Abstract
OBJECTIVES: The incidence of unilateral adrenal histoplasmosis in nonendemic areas is rare. This is even rarer if the host is immunocompetent. METHODS: We report a patient who was referred for unexplained weight loss who underwent a computed tomography scan of abdomen revealing a large unilateral adrenal nodule measuring 7.6 cm in size. RESULTS: Hormonal workup was negative including urine 24-hour free metanephrines, and the patient underwent unilateral adrenalectomy. The pathology showed budding yeast that stained with Gomori's methenamine silver (GMS) revealed the diagnosis of adrenal histoplasmosis. CONCLUSION: We encourage clinicians to include infection by Histoplasma capsulatum as well as other granulomatous diseases and tumors in the differential diagnosis of unilateral adrenal enlargement even in immunocompetent hosts living in nonendemic areas.
OBJECTIVES: The incidence of unilateral adrenal histoplasmosis in nonendemic areas is rare. This is even rarer if the host is immunocompetent. METHODS: We report a patient who was referred for unexplained weight loss who underwent a computed tomography scan of abdomen revealing a large unilateral adrenal nodule measuring 7.6 cm in size. RESULTS: Hormonal workup was negative including urine 24-hour free metanephrines, and the patient underwent unilateral adrenalectomy. The pathology showed budding yeast that stained with Gomori'smethenamine silver (GMS) revealed the diagnosis of adrenal histoplasmosis. CONCLUSION: We encourage clinicians to include infection by Histoplasma capsulatum as well as other granulomatous diseases and tumors in the differential diagnosis of unilateral adrenal enlargement even in immunocompetent hosts living in nonendemic areas.