Adrenocortical insufficiency caused by Cryptococcus neoformans: a case report and literature review

Abstract

Objective To explore the clinical features, diagnosis and treatment regimen of adrenal cryptococcosis so as to improve awareness of this disease for clinicians. Methods The clinical manifestations, laboratory indicators, imaging data and postoperative pathological results of a patient with adrenocortical insufficiency caused by Cryptococcus neoformans infection admitted to our hospital in June 2022 were collected and analyzed, and the related literature was reviewed. Results This patient presented with dizziness, fatigue, and multiple pigmentations throughout the whole body.Upper abdominal plain CT scan on June 24, suggested multiple nodular soft tissue shadows in the bilateral adrenal glands, and the scan on July 1 suggested mild inhomogeneous enhancement of bilateral adrenal nodules, which may be adrenal tumors.Retroperitoneal laparoscopic partial adrenalectomy was performed on July 13.Postoperative pathology indicated cryptococcosis.The antifungal treatment with itraconazole was stopped after 2 weeks by himself.In 3 months after the operation, CT revealed multiple adrenal masses on both sides, and itraconazole was taken again for treatment. Conclusion Patients with adrenal cryptococcosis usually have symptoms of adrenocortical insufficiency such as dizziness, fatigue, and multiple pigmentations throughout the whole body.Abdominal enhanced CT usually indicates adrenal nodules with inhomogeneous enhancement.The diagnosis depends on pathological examination, and antifungal therapy can be considered after adrenalectomy.

Keywords

• cryptococcus neoformans
• disseminated cryptococcosis
• adrenal gland
• adrenocortical insufficiency