J. Agarwal et al., Isolated Pneumocystis carinii infection of adrenal glands causing Addison's disease in a non-immunocompromised adult, ENDOCR PATH, 12(1), 2001, pp. 87-91
Pneumocystis carinii is primarily an opportunistic pathogen infecting patie
nts with AIDS and other immunocompromised patients, and ordinarily does not
affect immunocompetent persons. We report isolated P. carinii Infection of
bilateral adrenal glands in a non-immunocompromised adult male, leading to
fatal Addisonian crisis. Diagnosis of P. carinii was established on the ba
sis of cytopathology and microbiological tests, using conventional staining
techniques and direct immunofluorescence on ultrasound-guided fine needle
aspirates and trucut needle biopsy specimen from adrenal glands. P. carinii
pneumonia and other fungal infections of the adrenal glands were excluded
by appropriate tests. Absence of HIV infection was established by negative
ELISA for HIV I and II antibodies and Western blot analysis at the time of
presentation and 45 d later. Normal blood total leukocyte and CD4 lymphocyt
e counts and IgG and IgA levels confirmed the immunocompetent status of the
patient. The patient improved with anti-Pneumocystis treatment and cortico
steroid replacement, but succumbed to an episode of Addisonian crisis trigg
ered by a diarrheal illness.