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Open Access Highly Accessed Case report

Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report

Yayoi Matsuda1, Hisaya Kawate1, Yuka Okishige1, Ichiro Abe1, Masahiro Adachi1, Keizo Ohnaka2, Naoichi Satoh3, Junichi Inokuchi4, Katsunori Tatsugami4, Seiji Naito4, Masatoshi Nomura1 and Ryoichi Takayanagi1*

Author Affiliations

1 Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

2 Department of Geriatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

3 Department of Endocrinology and Diabetes, Iizuka Hospital, Iizuka 820-8505, Japan

4 Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

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BMC Infectious Diseases 2011, 11:340  doi:10.1186/1471-2334-11-340

Published: 14 December 2011

Abstract

Background

Cryptococcus species usually affect the central nervous system and lungs in immunocompromised hosts. Although the adrenal glands can be involved in disseminated cryptococcosis, primary adrenal insufficiency caused by the fungal infection is uncommon.

Case presentation

We present a case of primary adrenal insufficiency with bilateral adrenal masses and liver invasion in a 43-year-old man with mild type 2 diabetes mellitus. Cryptococcosis was diagnosed by fine-needle aspiration biopsy of the liver mass. The serum cryptococcal antigen titer was elevated to 1:256. After 6 months of antifungal therapy with fluconazole and amphotericin B, the size of the liver mass was decreased, but no significant changes were observed in the bilateral adrenal masses and the serum cryptococcal antigen titer remained elevated at 1:128. To control the cryptococcosis, a laparoscopic left adrenalectomy was performed, followed by antifungal therapy. After the unilateral adrenalectomy, the size of the remaining right adrenal mass was reduced and the serum cryptococcal antigen titer declined to 1:4.

Conclusions

This is the first report describing adrenal cryptococcosis with adrenal insufficiency and liver invasion without central nervous system involvement. Adrenal cryptococcosis should be considered in the differential diagnosis for patients with bilateral adrenal masses with primary adrenal deficiency. Unilateral adrenalectomy was quite effective in controlling the cryptococcosis in this case. Even in patients with bilateral adrenal cryptococcosis, unilateral adrenalectomy should be an option for treatment of disseminated cryptococcosis.