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Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients
Rajiv Ranjan Singh1, Narendra S Choudhary1, Rajesh Puri1, Mridula Guleria2, Haimanti Sarin2, Mukesh Nasa1, Rinkesh Bansal1, Vineet Shah1, Chitranshu Vashishtha1, Sumit Bhatia1, Amit Bhasin1, Suraj Bhagat1, Smruti Ranjan Misra1, Randhir Sud1
Institute of 1Digestive and Hepatobiliary Sciences and Department of 2Cytopathology, Medanta-The Medicity, Gurgaon, India.

Corresponding Author
Rajesh Puri


Background: There have been sporadic reports of histoplasmosis from India. Although traditionally considered a disease of immunocompromised hosts, immunocompetent patients presenting with adrenal histoplasmosis have been reported. Endoscopic ultrasound (EUS) provides easy and safe approach to adrenal glands for fine needle aspiration. 
Methods: We report 10 cases of adrenal histoplasmosis diagnosed by endoscopic ultrasound (EUS) guided FNA. The mean age at diagnosis was 54 ± 9 years, all were males. Eight patients were immunocompetent while two had cirrhosis; none of them was retrovirus positive. All patients presented with fever and weight loss, 8 had bilateral adrenal enlargement while 2 had isolated left adrenal enlargement. EUS features included hypoechoic (30%) or heteroechoic (70%) adrenal glands, presence of hypoechoic areas suggestive of necrosis within the gland was identified in 40% of these patients. Adrenal insufficiency was present in 1 patient (10%) which persisted even after successful treatment.
Conclusion: Adrenal histoplasmosis should be considered even in immunocompetent hosts presenting with constitutional symptoms and adrenal enlargement. EUS guided FNA is a safe and accurate modality for adrenal sampling.