ACUTE ADDISON CRISIS DUE TO HISTOPLASMOSI S OF THE ADRENAL-GLANDS

A 44-year-old man was admitted with symptoms compatible with Addison c risis. Abdominal computer tomography revealed extensive bilateral adre nal abscesses. Histoplasma capsulatum was cultured from a needle aspir ate. The patient was HIV-seronegative and had no underlying malignancy . He may have acquired the infection during several stays in endemic a reas in the United States, South America and Asia. The case was also r emarkable for moderate brain atrophy, thrombosis of the portal and spl enic veins and liver cirrhosis caused by alpha-1-antitrypsin deficienc y (phenotype MZ). The patient recovered fully under substitution of ad renal hormones and antifungal treatment. He received intravenous ampho tericin B (75 mg q24h) for 10 days, followed subsequently by oral trea tment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the in flammatory adrenal lesions.