Disseminated Histoplasmosis Involving the Vocal Cords and Bilateral Adrenal Glands: A Case Report

Background: Histoplasmosis is a systemic fungal infection primarily involving the lungs. Dissemination to the vocal cords and bilateral adrenal glands is exceedingly rare. This case report illustrates the clinical and radiological manifestations of the disease at these atypical sites, providing crucial insights for clinical differential diagnosis. Case Presentation: We present a 50-year-old male patient admitted with elevated blood glucose accompanied by recurrent fever and weight loss, with a history of diabetes mellitus and bat exposure. Imaging studies revealed a nodule in the left thyroid lobe (ACR TI-RADS 5), bilateral adrenal space-occupying lesions, and multiple pulmonary nodules. Fine-needle aspiration cytology of the thyroid nodule was suspicious for papillary thyroid carcinoma. Collectively, these findings suggested a radiological diagnosis of bilateral adrenal metastases. Ultimately, pathological examination of the adrenal biopsy confirmed the diagnosis of disseminated histoplasmosis. A comprehensive evaluation revealed involvement of the adrenal glands and vocal cord, with suspected pulmonary involvement. The patient experienced clinical improvement following antifungal therapy and was discharged. Conclusion: This case highlights that histoplasmosis can manifest as a disseminated infection in individuals with impaired immunity. When lesions present as nodules or masses on imaging, they are prone to misdiagnosis as metastatic disease or other neoplastic processes. Pathological examination remains paramount for definitive diagnosis. This report aims to increase clinicians' awareness of atypical presentations of histoplasmosis and emphasizes the critical importance of integrating epidemiological history, radiological findings, and pathological analysis for comprehensive diagnosis.