Bilateral Adrenal Histoplasmosis Incidentally Detected on ۱۸F- FDG PET/CT Scan in an Immunocompetent Man: A Case Report and Review of Literature

Adrenal histoplasmosis is an uncommon manifestation of Histoplasmacapsulatum infection and may closely mimic malignancy or granulomatousdiseases on imaging. We describe an immunocompetent ۵۱ year old manwith ۵ months of constitutional symptoms who underwent ۱۸F-FDGPET/CT for evaluation of occult disease. The scan revealed intensely FDGavid bilateral adrenal masses with necrotic components, with no otherabnormal sites. Biochemical testing confirmed primary adrenalinsufficiency. CT guided adrenal biopsy, targeted to the most FDG-avidviable component, demonstrated necrotizing granulomatousinflammation with intracellular yeast forms consistent with Histoplasmacapsulatum. Antifungal therapy with itraconazole plus glucocorticoidreplacement led to clinical improvement and interval regression of adrenallesions on follow-up. This case highlights the value of ۱۸F-FDG PET/CT fordetecting unsuspected adrenal histoplasmosis, localizing optimal biopsytargets, and facilitating timely treatment even in immunocompetentpatients presenting with nonspecific symptoms.

کلیدواژه ها:

Adrenal histoplasmosis ، ۱۸F-FDG PET/CT ، Adrenal insufficiency ، Fungal infection