Addison’s disease triggered by infection with mycobacterium abscessus, but not by adrenal tuberculosis or MAC pulmonary disease, in a subject with type 2 diabetes mellitus: case report

Abstract

Background Addison’s disease is primary adrenal dysfunction and is characterized by decrease of cortisol level and increase of adrenocorticotropic hormone (ACTH) level. It is known that infection is one of main causes of Addison’s disease. Among various infections, tuberculous infection accounts for the majority of them. Recently the number of subjects with non-tuberculous mycobacterial infection has been increased, and the infection can also bring about Addison’s disease. Mycobacterium avium complex (MAC) pulmonary disease accounts for the majority of non-tuberculous mycobacterial infection. Case presentation An 83-year-old female was suspected of having adrenal failure in our outpatient care and hospitalized in our institution. There was pigmentation in her face, hands and legs, especially in auricle and nail beds in her hands and legs. In rapid ACTH load test (0.25 mg of 1–24 ACTH), cortisol level was not increased at all. An abdominal computed tomography (CT) showed swelling of both adrenal glands accompanied by calcification. QuantiFERON test was negative and mycobacterium tuberculosis complex was negative in PCR test using bronchial lung lavage fluid. These data ruled out the possibility of adrenal tuberculosis. It is known that MAC pulmonary disease accounts for the majority of non-tuberculous mycobacterial infection. In this subject, however, anti-MAC antibody was negative and MAC-related bacteria were not detected in PCR test using bronchial lung lavage fluid. These data ruled out the possibility of MAC pulmonary disease. Mycobacterium abscessus (Mab) was positive in bronchial lung lavage fluid culture. Based on these data, we diagnosed this subject with Addison’s disease triggered by infection with mycobacterium abscessus, but not by adrenal tuberculous or MAC pulmonary disease. Decreased sodium level and increased eosinophil number were normalized and appetite loss was markedly mitigated after starting hydrocortisone therapy. A chest CT which was taken about 6 months later showed drastic reduction of consolidation in the upper lobe of the left lung although calcification in the adrenal gland was still observed. Conclusions We should bear in mind the possibility of Addison’s disease triggered by another type of infection rather than adrenal tuberculosis or MAC pulmonary disease.

Addison’s Disease: Diagnosis and Management Strategies

“… 70 , 71 Other infectious causes might trigger AD requiring a collateral infectious management, as well. 72 Of note, one study from 2023 on North Indian patients enrolled 89 individuals with AD (age: 15–83 years; median of 5.9) between 2006 and 2019. Interestingly, due to infectious aspects of this geographic area, the most frequent cause of AD was histoplasmosis (45%) followed by tuberculosis (15%) and then autoimmune AD (25%), and lymphoma (6%).…”

“…• AD due to tuberculosis • Additional anti-tuberculosis medication (rifampicin, isoniazid, ethambutol and pyrazinamide for 2 months → rifampicin, isoniazid for 10 months) Khan 71 • Case report • 50-y-old male with tuberculosis • AD due to infection • +Associating DM Kaneto 72 • Case report • 83-y-old female with AD due to mycobacterium abscesses Gunna 73 • Longitudinal study • N = 89 patients with AD (age between 15 and 83 y)…”