Journal of Multidisciplinary Healthcare (Oct 2021)
Progressive Disseminated Histoplasmosis Mimicking as Anal Carcinoma – Look at the Mountain, Not at Stone: A Case Report
Abstract
Mahaveer Singh,1 Abhishek Sharma,2 Kalpana Sankhala,3 Hemant Bareth,4 Supriya Suman4 1Department of Endocrinology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India; 2Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India; 3Department of Pathology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India; 4Department of Pharmacy Practice, Nims Institute of Pharmacy, Nims University Rajasthan, Jaipur, IndiaCorrespondence: Mahaveer SinghDepartment of Endocrinology, National Institute of Medical Sciences and Research Hospital, Nims University, Rajasthan, Jaipur, 303121, IndiaTel +918949836075Email [email protected]: Disseminated histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Here, we are presenting a case of shock who was diagnosed to have primary adrenal insufficiency. This 68-year-old man had bilateral adrenal mass and later presented with chronic fever and ulcerated anal mass in the oncology clinic. The oncologist made a provisional diagnosis of anal carcinoma with adrenal metastasis. He was suspected of having an adrenal crisis and was admitted to the intensive care unit. He also had granulomatous hepatitis and acute kidney injury. The working diagnosis was changed to systemic inflammatory/infective pathology. The biopsy of the anal tissue done to look for the aetiology showed Histoplasma. He was started on oral itraconazole therapy. He improved symptomatically (resolution of fever, improvement in pain) when assessed after seven days. His anal ulcer healed after 21 days of itraconazole therapy.Keywords: adrenal metastasis, anal carcinoma, Histoplasma, ulcerated anal mass
