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Disseminated histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum . Here, we are presenting a case of shock who was diagnosed to have primary adrenal insufficiency. This 68-year-old man had bilateral adrenal mass and later presented with chronic fever and ulcerated anal mass in the oncology clinic. The oncologist made a provisional diagnosis of anal carcinoma with adrenal metastasis. He was suspected of having an adrenal crisis and was admitted to the intensive care unit. He also had granulomatous hepatitis and acute kidney injury. The working diagnosis was changed to systemic inflammatory/infective pathology. The biopsy of the anal tissue done to look for the aetiology showed Histoplasma . He was started on oral itraconazole therapy. He improved symptomatically (resolution of fever, improvement in pain) when assessed after seven days. His anal ulcer healed after 21 days of itraconazole therapy.

IntroductionAngiokeratoma is a broad term that describes various conditions of asymptomatic hyperkeratotic vascular disorders with a histologic combination of hyperkeratosis and superficial dermal vascular ectasia. Here we are describing a case of recurrent angiokeratoma scroti. Case reportA 34-year-old patient presented to the surgery department with multiple small papules over the scrotum with a previous history of two recurrences. They were slowly progressive, itchy and not associated with any bleeding. Examination revealed multiple soft compressible papules of 3-4 mm diameter with excoriation marks. Systemic examination and routine investigations were normal. Histologically, they were composed of numerous dilated thin walled congested capillaries mainly in the papillary dermis. Epidermis revealed variable degree of acanthosis and elongation of rete ridges and mild hyperkeratosis. Electrocauterisation of lesions was done and the follow-up period of three months was uneventful. Conclusion Although angiokeratoma scroti is not an uncommon entity, good treatment modality with minimal adverse effects in terms of complete resolution of diffuse lesions, recurrence, scarring, crusting, bleeding or cosmetic results is still not available.