Indian Journal of Medical Research

CLINICAL IMAGES
Year
: 2014  |  Volume : 139  |  Issue : 5  |  Page : 786--787

18 F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient


S Padma1, Sreekala Sreehari2,  
1 Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences, Cochin 680 2041, India
2 Department of Pathology, Amrita Institute of Medical Sciences, Cochin 680 2041, India

Correspondence Address:
S Padma
Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences, Cochin 680 2041
India




How to cite this article:
Padma S, Sreehari S. 18 F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient.Indian J Med Res 2014;139:786-787


How to cite this URL:
Padma S, Sreehari S. 18 F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient. Indian J Med Res [serial online] 2014 [cited 2021 Mar 4 ];139:786-787
Available from: https://www.ijmr.org.in/text.asp?2014/139/5/786/136455


Full Text

A 80 year old diabetic male presented to the General Medicine department at Amrita Institute of Medical Sciences, Cochin, Kerala, India in January 2013 with complaints of severe weight loss. Despite extensive haematological tests, Mantoux test and chest X-ray, cause of weight loss was uncertain. A whole body 18 F FDG PET/CT ( 18 Fluorine labelled Flurodeoxyglucose Positron emission computed tomography/computed tomography, [Figure 1] was done to look for occult malignancy or infection. PET/CT images showed abnormal FDG uptake in bilateral adrenal glands. CT guided biopsy confirmed minimal active adrenal inflammation. Histopathologically special staining methods [PAS (Periodic acid-Schiff) and Geimsa stains] revealed fungal spores and organisms, thus confirming bilateral adrenal histoplasmosis as the underlying cause of weight loss [Figure 2]. Patient received itraconazole 200 mg twice daily oral doses and showed clinical improvement within 6 weeks of therapy.{Figure 1}{Figure 2}

Histoplasmosis, a fungal infection caused by Histoplasma capsulatum affects the reticulo-endothelial system [1] . Disseminated cases show involvement of liver, spleen, lymph nodes, marrow, and adrenal glands [1],[2] .

References

1Umeoka S, Koyama T, Saga T, Higashi T, Ito N, Kamoto T, et al. High 18 F-fluorodeoxyglocose uptake in adrenal histoplasmosis: a case report. Eur Radiol; 2005; 15 : 2483-6.
2Kumar N, Singh S, Govil S. Adrenal histoplasmosis: clinical presentation and imaging features in nine cases. Abdom Imaging 2003; 28 : 703-8.