# Adrenal Insufficiency due to Disseminated Cryptococcus in an Immunocompetent Individual

## TL;DR

A rare case of adrenal insufficiency caused by Cryptococcus in an immunocompetent man is reported, emphasizing the need for early diagnosis and treatment.

## Contribution

This case report highlights disseminated cryptococcosis as a rare cause of adrenal insufficiency in immunocompetent individuals.

## Key findings

- Adrenal enlargement and insufficiency were caused by Cryptococcus neoformans in an immunocompetent patient.
- FDG-PET imaging showed increased peripheral metabolic activity with central necrosis in the adrenal glands.
- Treatment with antifungal therapy improved symptoms and confirmed the importance of early diagnosis.

## Abstract

Primary adrenal insufficiency due to infiltrative fungal infections, such as Cryptococcus neoformans, is rare, particularly in immunocompetent patients. We present a case of an immunocompetent 61‐year‐old man who presented with bilateral adrenal enlargement and adrenal insufficiency, with a 3‐month history of generalised fatigue, weight loss and dizziness, as well as initial hyponatraemia and hyperkalaemia. Adrenal computed tomography (CT) revealed bilaterally enlarged adrenals, and fluorodeoxyglucose positron emission tomography (FDG‐PET) revealed increased peripheral metabolic surrounded by a photopenic core suggestive of central necrosis. Adrenal biopsies were consistent with Cryptococcus. Serum cryptococcal antigen (CrAg) testing was strongly positive (titres 1:1280) as was cerebrospinal fluid analysis (titre 1:160). The patient was commenced on hydrocortisone and fludrocortisone, with improvement in symptoms. Treatment involved induction therapy with intravenous liposomal amphotericin‐B 4 mg/kg daily and 5‐flucytosine 25 mg/kg four times daily for 2 weeks, followed by consolidation therapy with fluconazole. This case highlights the importance of considering disseminated cryptococcosis in immunocompetent individuals presenting with adrenal insufficiency. Early diagnosis and appropriate antifungal therapy are crucial.