Disseminated cryptococcosis causes adrenal insufficiency in an immunocompetent individual

Zui Sheng Hung, Yu Hsien Lai, Yung Hsiang Hsu, Chih Hsien Wang, Te Chao Fang, Bang Gee Hsu

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Disseminated cryptococcosis infection occurs mainly in the immunocompromised host. There are only a few reports describing disseminated cryptococcosis in immunocompetent patients. Here, we describe the case of a 46-year-old healthy man who presented with primary adrenal insufficiency with hyponatremia, hyperkalemia and skin pigmentation. Contrast-enhanced adrenal computed tomography (CT) revealed bilaterally enlarged adrenal glands without enhancement. CT-guided percutaneous adrenal gland biopsy showed caseous-like necrosis and embedded cryptococcosis. The serum cryptococcal antigen titer was 1: 512. After ten months of fluconazole treatment, the serum cryptococcal antigen titer remained elevated at 1: 256 and contrast-enhanced adrenal magnetic resonance imaging revealed continued enlargement of bilateral adrenal glands without enhancement. The patient is currently on a therapeutic regimen of prednisolone, fludrocortisone and fluconazole and is scheduled for regular outpatient follow-up.

Original languageEnglish
Pages (from-to)1023-1026
Number of pages4
JournalInternal Medicine
Volume49
Issue number11
DOIs
Publication statusPublished - 2010
Externally publishedYes

Keywords

  • Adrenal insufficiency
  • Disseminated cryptococcosis
  • Immunocompetent patient

ASJC Scopus subject areas

  • Internal Medicine

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