SHM Converge Scientific Abstract ePoster Gallery-Adrenal Mass Mystery: Do Not Be Fooled by Negative Serology

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This case report describes a 69-year-old man with progressive shortness of breath, weight loss, poor intake, and low-grade fevers. Imaging showed ground-glass opacities, calcified granulomas, and bilateral adrenal masses. Despite a clinical picture concerning for disseminated fungal infection, Histoplasma urine and serum antigen tests were negative, as were antibody studies, making the diagnosis unclear. A positive Blastomyces antibody was judged likely false positive.<br /><br />Because suspicion remained high, clinicians pursued biopsy. Right adrenal biopsy showed budding intracellular yeasts with extensive necrosis, and culture confirmed Histoplasma capsulatum, establishing disseminated histoplasmosis. The patient was treated with two weeks of amphotericin B, improved clinically, and was discharged on 12 months of itraconazole with infectious disease follow-up.<br /><br />The report emphasizes several key points:<br />- Disseminated histoplasmosis can occur even when serologic and antigen tests are negative.<br />- Negative testing should not delay further evaluation, especially biopsy, when clinical suspicion remains high.<br />- Standard post-treatment monitoring with serial antigen or antibody testing may be unhelpful if assays were initially negative, so close symptom-based follow-up is important.<br />- Adrenal involvement can mimic other processes such as necrosis or hemorrhage on imaging, adding diagnostic difficulty.<br /><br />Overall, the case highlights the limitations of serology in histoplasmosis and the importance of early tissue diagnosis in atypical presentations.

Asset Subtitle

Chrishanthi Pathmanabhan

Meta Tag

Author List Chrishanthi Pathmanabhan, Felicia R. D’Souza, Hyeokchan Kwon

Category Clinical Vignettes

Concept Histoplasmosis

Concept Adrenal Mass

Concept Adrenal Biopsy

Concept Systemic Symptoms

Concept Serologic Test

Distinguished Non-Finalist

Presenter Organization Perelman School of Medicine

Presenting Author Chrishanthi Pathmanabhan

Track Adult

Keywords

disseminated histoplasmosis

Histoplasma capsulatum

negative antigen tests

adrenal masses

biopsy diagnosis

fungal infection

ground-glass opacities

intracellular yeasts

amphotericin B

itraconazole

Histoplasmosis

Adrenal Mass

Adrenal Biopsy

Systemic Symptoms

Serologic Test