A Rare Presentation of Adrenal Histoplasmosis in an Immunocompetent Patient as Adrenal Crisis

A 44-year-old diabetic male presented with hypovolemic shock along with cough-cold, weakness, and low-grade fever for the past four months. On laboratory investigation, there were hyponatremia, hyperkalemia, and hypercalcemia. Persistently low parathyroid levels along with a positive ACTH stimulation test confirmed primary Addison’s disease. On ultrasonography, there was a bilateral adrenal mass over which CT-guided FNAC was done. PAS stain of the sample showed intracellular yeast cells resembling histoplasmosis and on culture at 25°C it showed microconidia with successful conversion of mycelium to yeast. The patient was treated with Liposomal Amphotericin B over two weeks and steroids, with which the patient gradually improved.