Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Abstract

Background:There have been sporadic reports of histoplasmosis from India. Although traditionally considered a disease of immunocompromised hosts, immunocompetent patients presenting with adrenal histoplasmosis have been reported. Endoscopic ultrasound (EUS) provides easy and safe approach to adrenal glands for fine needle aspiration. Methods: We report 10 cases of adrenal histoplasmosis diagnosed by endoscopic ultrasound (EUS) guided FNA. The mean age at diagnosis was 54 ± 9 years, all were males. Eight patients were immunocompetent while two had cirrhosis; none of them was retrovirus positive. All patients presented with fever and weight loss, 8 had bilateral adrenal enlargement while 2 had isolated left adrenal enlargement. EUS features included hypoechoic (30%) or heteroechoic (70%) adrenal glands, presence of hypoechoic areas suggestive of necrosis within the gland was identified in 40% of these patients. Adrenal insufficiency was present in 1 patient (10%) which persisted even after successful treatment. Conclusion: Adrenal histoplasmosis should be considered even in immunocompetent hosts presenting with constitutional symptoms and adrenal enlargement. EUS guided FNA is a safe and accurate modality for adrenal sampling.

Can urinary histoplasma antigen test improve the diagnosis of histoplasmosis in a tuberculosis endemic region?

“…Ten of our patients were on empirical ATT on the basis of granulomatous inflammation, emphasising the need to consider histoplasmosis in the differential diagnosis of tuberculosis. Adrenal enlargement was seen in 11 (29.7%) of our patients making it an important diagnostic clue, consistent with other Indian studies . Presence of oral ulcers is also a clinical clue towards diagnosis.…”

Clinical and Morphological Spectrum of Histoplasmosis on Cytology Along with the Review of Literature

“…The organisms were seen in both intra- and extracellular location. Singh [14] reported 10 cases of adrenal histoplasmosis diagnosed on endoscopic ultrasound-guided FNAC. They studied the clinical and radiological spectrum.…”