Insuficiencia suprarrenal primaria asociada a micosis sistémica
Palabras clave:
insuficiencia suprarrenal, tuberculosis extrapulmonar, histoplasmosis
Resumen
La insuficiencia suprarrenal primaria o enfermedad de Addison es un trastorno poco común y generalmente progresivo, producido por la hipoperfusión de la corteza. Anteriormente se ha considerado a la tuberculosis como la principal causa infecciosa de esta entidad. Sin embargo, en la actualidad, la autoinmune representa la principal etiología.
Se describe el caso de un paciente de sexo masculino, de 50 años, portador de hipertensión arterial y antecedente de tuberculosis pulmonar, ganglionar y meníngea, que culminó su tratamiento anti bacilar hace 7 años.
Acude por cuadro de 2 meses de evolución de vómitos con progresión a la intolerancia a la vía oral, acompañado de pérdida de peso más astenia. La tomografía computada mostró agrandamiento irregular de ambas suprarrenales. Se realizó una biopsia guiada por tomografía y el estudio histopatológico informó Histoplasma.
Citas
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7. López LF, Tobón ÁM, Cáceres DH, Chiller T, Litvintseva AP, Gade L, et al. Application of real-time PCR assays for the diagnosis of histoplasmosis in human FFPE tissues using three molecular targets. J Fungi (Basel) [Internet]. 2023 [cited 2023 Nov 10]; 9(7):700. Available from: https://pubmed.ncbi.nlm.nih.gov/37504689/
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9. Vargas García LF, Ramírez Rosales A, De Leija Gómez MA, Ayala-Gaytán JJ. Bilateral adrenal histoplasmosis: case report and literature review. Enf Infec Microbiol. 2014 [cited 2023 Oct 10];34(1):37–42. Available from: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=49958
10. Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Quiros Roldan E, et al. Disseminated histoplasmosis as AIDS presentation. Case report and comprehensive review of current literature. Mediterr J Hematol Infect Dis [Internet]. 2018 [cited 2023 Nov 10];10(1):e2018040. Available from: http://dx.doi.org/10.4084/MJHID.2018.040
11. Bhattacharyya K, Pal S, Dutta A, Bhattachryya PP, Laskar S. Histoplasmosis of adrenal gland: A 5 years’ review from a multispecialty diagnostic centre. J Lab Physicians [Internet]. 2022 [cited 2023 Oct 10];15(2):243–52. Available from: http://dx.doi.org/10.1055/s-0042-1757587
12. Barrera Henao AY, González Paya G. El papel en la salud pública de histoplasma capsulatum. Rev Sist Prod Agroecol [Internet]. 2015 [citado 10 Nov 2023 ];6(2):80–108. Disponible en: http://dx.doi.org/10.22579/22484817.673
13. Sánchez-Tadeo MT, Estrada-Moreno BE, Castañeda-Chávez A, Flores-Martínez CA. Histoplasmosis cutánea primaria: serie de casos con diagnóstico histopatológico en el periodo 2021-2023 en el Hospital General de Occidente. Salud Jalisco [Internet]. 2024 [citado 10 Nov 2023 ];11(1):37–43. Disponible en: http://dx.doi.org/10.35366/114841
14. Madhavan P, Nallu R, Luthra P. Histoplasmosis: An unusual cause of adrenal insufficiency. AACE Clin Case Rep [Internet]. 2021 [cited 2023 Oct 10];7(1):29–31. Available from: http://dx.doi.org/10.1016/j.aace.2020.11.005
2. Sarin BCh, Sibia K, Kukreja S. Study of adrenal function in patients with tuberculosis. Indian J Tuberc [Internet]. 2018 [cited 2023 Oct 10];65(3):241–5. Available from: http://dx.doi.org/10.1016/j.ijtb.2017.08.033 Subscription required
3. Caceres DH, Tobón AM, Cleveland AA, Scheel ChM, Berbesi DY, Ochoa J, et al. Clinical and laboratory profile of persons living with human immunodeficiency virus/acquired immune deficiency syndrome and histoplasmosis from a Colombian hospital. Am J Trop Med Hyg [Internet]. 2016 [cited 2023 Oct 10];95(4):918–24. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5062801/
4. van Haren Noman S, Visser H, Muller AF, Limonard GJ. Addison’s disease caused by tuberculosis: Diagnostic and therapeutic difficulties. Eur J Case Rep Intern Med [Internet]. 2018 [cited 2023 Oct 10];5(8):000911. Available from: http://dx.doi.org/10.12890/2018_000911
5. Aguilar F G, Araujo L P. Histoplasmosis en pacientes con infección por VIH en Paraguay: Casuística del Laboratorio Central del Ministerio de Salud Pública en el período 1993-2017. Rev chil infectol [Internet]. 2022 [citado 10 Oct 2023 ];39(4):432–6. Disponible en: http://dx.doi.org/10.4067/s0716-10182022000400432
6. Agarwal M, Gupta ML, Shadrach BJ, Bharti N. Progressive disseminated histoplasmosis in an immunocompetent host: A rare presentation of an uncommon disease. Acta Biomed [Internet]. 2021 [cited 2023 Oct 10];92(Supp 1): e2021134. Available from: http://dx.doi.org/10.23750/abm.v92iS1.10213
7. López LF, Tobón ÁM, Cáceres DH, Chiller T, Litvintseva AP, Gade L, et al. Application of real-time PCR assays for the diagnosis of histoplasmosis in human FFPE tissues using three molecular targets. J Fungi (Basel) [Internet]. 2023 [cited 2023 Nov 10]; 9(7):700. Available from: https://pubmed.ncbi.nlm.nih.gov/37504689/
8. Ecka RS, Sharma M, Tomar V. Disseminated histoplasmosis in an immunocompetent haweli dweller: A diagnosis and follow-up by endoscopic ultrasound-guided fine-needle aspiration. J Cytol [Internet]. 2015 [cited 2023 Nov 10];32(2):142–4. Available from: http://dx.doi.org/10.4103/0970-9371.160597
9. Vargas García LF, Ramírez Rosales A, De Leija Gómez MA, Ayala-Gaytán JJ. Bilateral adrenal histoplasmosis: case report and literature review. Enf Infec Microbiol. 2014 [cited 2023 Oct 10];34(1):37–42. Available from: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=49958
10. Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Quiros Roldan E, et al. Disseminated histoplasmosis as AIDS presentation. Case report and comprehensive review of current literature. Mediterr J Hematol Infect Dis [Internet]. 2018 [cited 2023 Nov 10];10(1):e2018040. Available from: http://dx.doi.org/10.4084/MJHID.2018.040
11. Bhattacharyya K, Pal S, Dutta A, Bhattachryya PP, Laskar S. Histoplasmosis of adrenal gland: A 5 years’ review from a multispecialty diagnostic centre. J Lab Physicians [Internet]. 2022 [cited 2023 Oct 10];15(2):243–52. Available from: http://dx.doi.org/10.1055/s-0042-1757587
12. Barrera Henao AY, González Paya G. El papel en la salud pública de histoplasma capsulatum. Rev Sist Prod Agroecol [Internet]. 2015 [citado 10 Nov 2023 ];6(2):80–108. Disponible en: http://dx.doi.org/10.22579/22484817.673
13. Sánchez-Tadeo MT, Estrada-Moreno BE, Castañeda-Chávez A, Flores-Martínez CA. Histoplasmosis cutánea primaria: serie de casos con diagnóstico histopatológico en el periodo 2021-2023 en el Hospital General de Occidente. Salud Jalisco [Internet]. 2024 [citado 10 Nov 2023 ];11(1):37–43. Disponible en: http://dx.doi.org/10.35366/114841
14. Madhavan P, Nallu R, Luthra P. Histoplasmosis: An unusual cause of adrenal insufficiency. AACE Clin Case Rep [Internet]. 2021 [cited 2023 Oct 10];7(1):29–31. Available from: http://dx.doi.org/10.1016/j.aace.2020.11.005
