Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual

Misa Ito; Takashi Hinata; Kaku Tamura; Ayano Koga; Toshimitsu Ito; Hiroko Fujii; Fumihiko Hirata; Hidenari Sakuta

doi:10.2169/internalmedicine.56.7356

CASE REPORTS

Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual

Misa Ito, Takashi Hinata, Kaku Tamura, Ayano Koga, Toshimitsu Ito, Hiroko Fujii, Fumihiko Hirata, Hidenari Sakuta

Author information

Misa Ito
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Takashi Hinata
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Kaku Tamura
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Ayano Koga
Department of Pathology, Japan Self Defense Forces Central Hospital, Japan
Toshimitsu Ito
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Hiroko Fujii
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Fumihiko Hirata
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan
Hidenari Sakuta
Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Japan

Keywords: Primary adrenal insufficiency, Cryptococcus spp., fungemia, meningitis, immunocompetent, adrenalectomy

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 10 Pages 1259-1264

DOI https://doi.org/10.2169/internalmedicine.56.7356

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Abstract

We present a case of cryptococcosis with adrenal insufficiency and meningitis in a healthy host without any risk factors. Antifungal therapy did not reduce the cryptococcal antigen titers of the cerebrospinal fluid and serum or the bilateral adrenal gland enlargement. It was suggested that the adrenal glands were the focus of persistent fungemia. Removal of both adrenal glands brought about a response to antifungal therapy. We conclude that if antifungal therapy is ineffective, bilateral adrenalectomy is an effective measure for treatment of such patients. Cryptococcosis is a possible cause of primary adrenal insufficiency in immunocompetent patients.

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