DISSEMINATED BIPOLARIS INFECTION IN AN ASTHMATIC PATIENT - CASE-REPORT

We present the case of a patient with a history of asthma who develope d cough and hemoptysis that were unresponsive to antituberculous thera py. Chest roentgenography demonstrated right-sided collapse with conso lidation and a pleural effusion. Bronchial biopsy revealed fungal hyph ae, and cultures later yielded Bipolaris spicifera. In addition, weigh t loss and intractable hypotension in association with hyponatremia an d elevated potassium levels suggested addisonian crisis, which was con firmed by measurement of serum ACTH and cortisol levels. Computed tomo graphy of the abdomen revealed bilateral adrenal involvement. Tissue o btained on biopsy of the adrenal glands yielded B. spicifera. The pati ent responded to treatment with 2 g of iv amphotericin B; the adrenal masses and pneumonia resolved, and he remained well until last seen in July 1992. However, he requires replacement therapy with prednisone a nd fludrocortisone. On review of the available literature, we were una ble to find a previously reported case.