Addison's disease due to adrenal insufficiency in an immunocompetent patient with disseminated cryptococcosis. Case report.

Abstract

Systemic mycoses, such as cryptococcosis, mainly affect the lungs and central nervous system; however, involvement of other organs, such as the adrenal glands, is rare. This has been described in some cases of primary adrenal insufficiency (PAI) of fungal origin, which are associated with high mortality. We present the case of a 65-year-old immunocompetent man who presented clinical manifestations of adrenal insufficiency. Biochemical tests confirmed PAI, and abdominal tomography revealed hyperplasia of both adrenal glands, predominantly on the left side. Left adrenalectomy was performed, and pathological examination identified granulomas and fungal structures compatible with Cryptococcus spp. The patient received hormone replacement therapy and antifungal treatment, with favorable outcome. Cryptococcal adrenalitis should be considered in the differential diagnosis of PAI, particularly in the presence of relevant epidemiological history, and timely treatment is key to improving prognosis.