M. Kawamura et al., DISSEMINATED CRYPTOCOCCOSIS ASSOCIATED WITH ADRENAL MASSES AND INSUFFICIENCY, The American journal of the medical sciences, 316(1), 1998, pp. 60-64
A case of primary adrenal insufficiency with bilateral adrenal masses
and meningitis due to disseminated cryptococcosis in a patient with mi
ld non-insulin-dependent diabetes is presented. The diagnosis was made
by fine-needle aspiration biopsy cytology. Although the meningitis re
sponded to antifungal therapy, the bilateral adrenal gland enlargement
did not change. Reflecting this, cryptococcal antigen titers became n
egative in CSF, but fell to 1:8 in serum, Although antifungal therapy
continued, cryptococcal antigen titer increased both in CSF and serum
for 50 days. Because the adrenal glands were the apparent focus for th
e persistent fungemia, bilateral adrenalectomy was performed, Antifung
al therapy for an additional 15 months was needed to achieve negative
serum cryptococcal antigen titers. Although adrenal insufficiency due
to disseminated cryptococcosis is rare in healthy hosts, it should be
included in differential diagnosis of unilateral and bilateral adrenal
masses.