Adrenal paracoccidioidomycosis with atypical presentation and fatal outcome: a case report
DOI:
https://doi.org/10.5281/zenodo.21896069Keywords:
paracoccidioidomycosis, adrenal glands, adrenal insufficiency, adrenocorticotropic hormone, amphotericin B, case reportAbstract
Introduction: Adrenal paracoccidioidomycosis most often affects men aged 30 to 60 years who work in agriculture or rural settings, and it may clinically and radiologically mimic a primary adrenal neoplasm.
Objective: To describe a case of paracoccidioidomycosis with bilateral adrenal involvement, initially interpreted as a possible adrenal adenoma, that progressed to severe adrenal insufficiency and a fatal outcome.
Case presentation: We present the case of a 44-year-old man, chronic smoker and farmer, with no known baseline disease, who had a three-year history of persistent postprandial nausea and vomiting, 30 kg weight loss and progressive generalized weakness, and who had previously required a 34-day hospitalization. Contrast-enhanced abdominal computed tomography and ultrasonography showed a bilateral hypodense adrenal lesion, with initial suspicion of bilateral adrenal adenoma. Guided biopsy confirmed paracoccidioidomycosis. Amphotericin B was started, with two successive interruptions because of adverse drug reaction, renal function deterioration and gastrointestinal intolerance. Given persistent imaging findings, oncology evaluation was requested to rule out an ACTH-hypersecreting adrenal adenoma; ACTH was 550.0 pg/ml. The patient then showed progressive clinical and laboratory deterioration, with hemodynamic instability requiring intensive care and emergency rescue hemodialysis. Subsequent course included sustained hemodynamic deterioration, electrolyte imbalance and severe metabolic acidosis, with fatal outcome.
Conclusions: This case illustrates a severe and uncommon form of adrenal paracoccidioidomycosis in which coexistence of findings suggestive of an ACTH-hypersecretory process could not be excluded because of the fatal outcome, and it underscores the importance of early differential diagnosis between fungal infection and primary neoplasia in bilateral adrenal lesions.
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Copyright (c) 2024 Nelly Gómez Larrosa, Vivian Gayoso Álvarez, Fabiana Giménez Chamorro, Isamar Fabiola Ferreira, Zara Escobar Benítez (Autor/a)
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