Cases reported "Histoplasmosis"

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1/32. Disseminated histoplasmosis presenting as bilateral adrenal masses.

    histoplasma capsulatum is a universal dimorphic fungus found mainly in soil contaminated with excrement of birds and bats. Bilateral adrenal masses with massive tissue destruction are a rare primary presentation of disseminated histoplasmosis. As it behaves as an opportunistic pathogen there is a higher susceptibility for dissemination on those patients with immunodeficiency or immunosuppression. We report a case in an elderly diabetic patient with bilateral adrenal enlargement, diagnosed as histoplasmosis only after surgical exploration, with symptoms probably occurring at least 60 years after the original infection. She was successfully treated with itraconazole.
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2/32. histoplasmosis in eastern india: the tip of the iceberg?

    Systemic histoplasmosis has various clinical presentations and is of especially concern in immunocompromised patients. A high index of suspicion is required for its diagnosis. A total of 38 cases had been reported from india up to 1996. The most frequent occurrence of cases was around Calcutta in eastern india where the previous case was detected 20 years earlier. However, we have diagnosed 5 cases in the past 2 years from eastern india which are reported here. These cases may indicate under-diagnosis and under-reporting of histoplasmosis in india. All 5 patients had disseminated disease with multisystem involvement including 2 with bilateral adrenal enlargement. Two were diabetic and only 1 patient was infected with hiv.
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3/32. Adrenal bilateral incidentaloma by reactivated histoplasmosis.

    We report a case of bilateral adrenal incidentaloma caused by the capsulatum variety of histoplasma capsulatum diagnosed in a 74 years old man born in and a life time resident of Treviso, italy, with the exception of two years spent in pakistan (1964-1966) as a well-driller. The patient was hospitalized in 1995 for alcoholic chronic hepatitis, chronic helicobacter pylori gastritis and post-infarction ischemic cardiomyopathy. Abdominal ultrasound incidentally showed bilateral adrenal masses (the right one 6.3 cm in diameter) confirmed by computed tomography, with adrenal function within normal limits. After three months, the patient was again hospitalized due to evening fever, asthenia, anorexia, weight loss and occasional hyperhidrosis. Abdominal ultrasound showed an increase of the right adrenal lesion with normal adrenal function. Ultrasound-guided fine needle aspiration did not prove useful for diagnosis. Accordingly, a laparotomy with bilateral biopsy was performed; histology showed the presence of numerous tissue form cells of H. capsulatum variety capsulatum. serum anti-H. capsulatum antibodies were negative. Since March, 1996, the patient was given itraconazole and his symptoms quickly regressed but the computed tomography findings, however, have not changed and the patient has adrenal hypofunction that is being treated with cortisone acetate.
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4/32. histoplasmosis: an unusual presentation.

    histoplasma capsulatum (HC) infection is rare in india. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin b and is under regular follow-up with no complaints now.
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5/32. histoplasma capsulatum in adrenal gland aspirate--a case report.

    We report a case of disseminated histoplasmosis in a 60-year-old non-immunocompromised patient who presented to us with fever and hepatosplenomegaly. Sonographic & CT examination of the abdomen showed bilateral adrenal masses. Cytological examination of the aspirated material from the mass showed yeast forms of H. capsulatum.
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6/32. A case of histoplasma capsulatum causing granulomatous liver disease and Addisonian crisis.

    A 56-year-old man with persistently elevated liver enzyme levels, fatigue, lethargy and a 9.0 kg weight loss over six months underwent a percutaneous liver biopsy that demonstrated multiple granulomas. Screening serologies were positive for histoplasmosis, and he was started on itraconazole treatment. He returned to hospital the same night with coffee-ground emesis and in Addisonian crisis requiring parenteral steroids and intensive care unit support. An abdominal computed tomography scan revealed bilaterally enlarged, nonenhancing adrenal glands suggestive of infarcts, presumed secondary to histoplasmosis. Treatment was initiated with amphotericin b, and histoplasma capsulatum was cultured from his urine and cerebrospinal fluid. A serum immunodiffusion test was also positive for both H and M bands, indicating active infection with histoplasmosis species. His serum and urine samples were also weakly positive for the antigen. Despite complications of renal failure, pneumonia and congestive heart failure, he recovered with medical therapy and was discharged home to complete a prolonged course of itraconazole therapy. While hepatic granulomas often reflect an occult disease process, the cause may remain undiscovered in 30% to 50% of patients despite exhaustive investigations. H capsulatum is an uncommon cause of granulomatous liver disease, and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated infection.
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7/32. histoplasmosis presenting with progressively worsening backache--a case report.

    INTRODUCTION: Bilateral adrenal enlargement is often the result of disseminated malignant disease, and this diagnosis is particularly likely in a patient with severe weight loss. We describe a case with bilateral adrenal enlargement presenting with progressively worsening backache as a prominent symptom. CLINICAL PICTURE: A 55-year-old man presented with intermittent low back pain which was progressively worsening, fever, anorexia, low back pain and a 10-kg weight loss. He had underlying diabetes mellitus and ischaemic heart disease. He gave a history of travel to caves for worship. Clinically, the most significant findings included nodular lesions in the anterior fauces and left palatoglossal region. Computed tomographic scan revealed bilateral adrenal masses. Biopsies were taken from the palatal nodules, which revealed histiocytes with numerous histoplasma organisms. TREATMENT: He was commenced on itraconazole 200 mg daily for a period of 9 months. There was a dramatic initial response with settling of his fever and this was followed by subjective improvement in his well-being. OUTCOME: He is presently on follow-up and has completed 9 months of itraconazole therapy with resolution of all his symptoms and has gained about 10 kg of weight.
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8/32. Adrenal histoplasmosis.

    A 60 year old diabetic was admitted with the history of low grade fever and weight loss of six weeks duration. After investigations, he was detected to have bilateral adrenal masses which on biopsy proved to be due to histoplasmosis. He was treated with itraconazole and made complete recovery.
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9/32. histoplasmosis presenting as addisonian crisis in an immunocompetent host.

    A 71-year-old man with presumptively treated pulmonary tuberculosis ten years earlier and previous alcoholism presented with adrenal insufficiency. hiv serology was negative. A computerized tomography scan of the abdomen showed enlarged right adrenal. He recovered after emergency treatment with hydrocortisone IV. Right adrenalectomy was performed. histoplasmosis was diagnosed and the patient was treated with itraconazole, corticosteroid replacement, and discharged with good health.
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10/32. Progressive disseminated histoplasmosis 10 years after return out of africa in an immunocompetent host.

    We report on a patient without immunologic dysfunction who developed a reactivation of a latent histoplasma infection, acquired during a previous stay in africa more than 10 years before. The current reactivation resulted in a subacute progressive disseminated histoplasmosis. He developed progressive weight loss, prostration and different oropharyngeal lesions together with bilateral adrenal masses on CT scan. The diagnosis was made on histology of biopsies of the oropharyngeal lesions. All systemic symptoms normalised, the oropharyngeal lesions disappeared and the adrenal masses regressed under amphotericin b therapy followed by itraconazole consolidation therapy.
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