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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(02): 243-252
DOI: 10.1055/s-0042-1757587
Original Article

Histoplasmosis of Adrenal Gland: A 5 Years' Review from a Multispecialty Diagnostic Centre

Kumkum Bhattacharyya
1   Department of Microbiology, Quadra Medical Services, Kolkata, West Bengal, India
2   Department of Microbiology, Institute of Post Graduate Medcal Education & Research, Kolkata, West Bengal, India
,
Suranjan Pal 
3   Department of Microbiology, Raiganj Government Medical College, Raiganj, Uttar Dinajpur, West Bengal, India
,
Ashis Dutta
4   Department of Pathology, Quadra Medical Services, Kolkata, West Bengal, India
,
Pinak Pani Bhattachryya
5   Department of Radiology, Quadra Medical Services, Kolkata, West Bengal, India
,
Saurabh Laskar
1   Department of Microbiology, Quadra Medical Services, Kolkata, West Bengal, India
› Author Affiliations Funding None.
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Abstract

Objective Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum. Histoplasmosis is considered to be endemic to India, especially the Gangetic belt. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients, whereas isolated adrenal involvement as the presenting manifestation in immunocompetent is uncommon. We aimed to determine the clinicopathological and radiological findings of adrenal histoplasmosis in immunocompetent patients attending a multispecialty diagnostic center referred from different clinics and hospitals.

Materials and Methods All tissue samples were initially examined microscopically by performing potassium hydroxide (KOH) wet mounts, followed by culture on two tubes of Sabouraud dextrose agar and phase conversion. Histopathological correlation was done using tissue stains, hematoxylin and eosin, periodic acid–Schiff, and Gomori methenamine silver.

Results We evaluated 84 clinically suspected cases radiologically for adrenal mass. The pathological and microbiological work-up was done from these suspected cases. A total of 19 cases were evident from the tissue stain and fungal culture methods. The affected population were mostly above 45 years and male. Seven patients had bilateral adrenal involvement. All these patients received amphotericin B and/or itraconazole treatment, which led to symptomatic improvement in most cases.

Conclusion Diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients presenting with nonspecific symptoms, clinical signs, and laboratory and radiological features that often resemble adrenal neoplasms. Clinical specimens, together with fungal culture, must be sent for cytopathology/histopathology for a definite diagnosis and appropriate management.

Keywords

histoplasmosis - mycosis - adrenal gland

Authors' Contributions

P.P.B. contributed to the concept and design; A.D., K.B., S.L., and P.P.B. contributed to data collection and processing; A.D., K.B., S.L., and S.P. contributed to analysis and interpretation; S.P. and K.B. contributed to drafting the manuscript; K.B. and S.P. contributed to the manuscript's critical review.




Publication History

Article published online:
20 October 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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