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Abstract：
Objective Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum . Histoplasmosis is considered to be endemic to India, especially the Gangetic belt. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients, whereas isolated adrenal involvement as the presenting manifestation in immunocompetent is uncommon. We aimed to determine the clinicopathological and radiological findings of adrenal histoplasmosis in immunocompetent patients attending a multispecialty diagnostic center referred from different clinics and hospitals. Materials and Methods All tissue samples were initially examined microscopically by performing potassium hydroxide (KOH) wet mounts, followed by culture on two tubes of Sabouraud dextrose agar and phase conversion. Histopathological correlation was done using tissue stains, hematoxylin and eosin, periodic acid-Schiff, and Gomori methenamine silver. Results We evaluated 84 clinically suspected cases radiologically for adrenal mass. The pathological and microbiological work-up was done from these suspected cases. A total of 19 cases were evident from the tissue stain and fungal culture methods. The affected population were mostly above 45 years and male. Seven patients had bilateral adrenal involvement. All these patients received amphotericin B and/or itraconazole treatment, which led to symptomatic improvement in most cases. Conclusion Diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients presenting with nonspecific symptoms, clinical signs, and laboratory and radiological features that often resemble adrenal neoplasms. Clinical specimens, together with fungal culture, must be sent for cytopathology/histopathology for a definite diagnosis and appropriate management.
摘要：
目的组织胞浆菌病是由双态真菌荚膜组织胞浆菌引起的一种传染病。组织胞浆菌病被认为是印度特有的，尤其是恒河带。播散性组织胞浆菌病可能会影响几乎所有系统。已在免疫受损患者中描述了无症状肾上腺受累的播散性组织胞浆菌病，而孤立的肾上腺受累作为免疫能力的表现并不常见。我们旨在确定在不同诊所和医院转介的多专业诊断中心就诊的有免疫能力的患者中肾上腺组织胞浆菌病的临床病理和放射学发现。材料和方法所有组织样品最初通过进行氢氧化钾（KOH）湿固定显微镜检查，然后在Sabouraud葡萄糖琼脂的两个管上培养并进行相转化。使用组织染色进行组织病理学相关性，苏木精和伊红,高碘酸-希夫，和Gomori美沙胺银。结果我们通过放射学评估了84例临床可疑的肾上腺肿块病例。对这些疑似病例进行了病理和微生物学检查。从组织染色和真菌培养方法来看，共有19例明显。受影响的人口大多在45岁以上，男性。7例患者双侧肾上腺受累。所有这些患者接受两性霉素B和/或伊曲康唑治疗，在大多数情况下导致症状改善。结论侵袭性真菌感染的诊断需要较高的怀疑指标,尤其是出现非特异性症状的免疫功能正常的患者，临床体征,以及通常类似肾上腺肿瘤的实验室和放射学特征。临床标本,与真菌培养一起，必须进行细胞病理学/组织病理学检查以进行明确诊断和适当处理。
