RESUMEN
Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.
A paracoccidioidomicose e a histoplasmose são infecções fúngicas sistêmicas endêmicas no Brasil. As formas clínicas disseminadas são incomuns em pacientes imunocompetentes. Nós descrevemos dois pacientes HIV-negativos com infecções fúngicas disseminadas, paracoccidioidomicose e histoplasmose, que foram diagnosticadas por biópsias de lesões de supra-renal. Ambos foram tratados por períodos prolongados com antifúngicos orais, evoluindo com boa resposta terapêutica.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Dermatosis Facial/diagnóstico , Histoplasmosis/diagnóstico , Paracoccidioidomicosis/diagnóstico , Enfermedades de las Glándulas Suprarrenales/microbiología , Biopsia , Brasil , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Dermatosis Facial/microbiología , Inmunocompetencia/fisiologíaRESUMEN
Histoplasmosis is a fungal disease that is endemic in Brazil. It may present as chronic pulmonary infection or in disseminated form. Disseminated histoplasmosis frequently affects the adrenal gland; however, unilateral involvement in immunosuppressed patients is the usual presentation. We report a case of an elderly immunocompetent male with history of weight loss, fever and bilateral adrenal mass who was successfully treated with itraconazole.
Histoplasmose é uma doença fúngica endêmica no Brasil que pode se apresentar como infecção pulmonar crônica ou na forma disseminada. A histoplasmose disseminada freqüentemente acomete a glândula adrenal; entretanto, ocorre mais em pacientes imunossuprimidos e de forma unilateral. Relatamos um caso de um homem idoso imunocompetente com história de perda de peso, febre e massa adrenal bilateral que foi tratada com itraconazol, com sucesso.
Asunto(s)
Humanos , Masculino , Anciano , Enfermedades de las Glándulas Suprarrenales/microbiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Histoplasmosis/tratamiento farmacológico , Itraconazol/uso terapéutico , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/tratamiento farmacológico , Histoplasmosis/diagnóstico , InmunocompetenciaRESUMEN
We report a case history of an 84-year-old elderly male patient that presented with a clinical picture suggestive of adrenal failure and bilateral adrenal nodules detected by abdominal computed tomography. A fine needle-guided biopsy was inconclusive for achieving a final diagnosis. The patient died due to septic shock and the autopsy disclosed histoplasmosis with extensive bilateral necrosis of the adrenal glands. Although the adrenal involvement in chronic disseminated histoplasmosis has been described, there have been few reports of the infection being associated with adrenal insufficiency.