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18F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient

Publisher : The Indian journal of medical research

Campus : Kochi

School : School of Medicine

Department : Nuclear Medicine

Year : 2014

Abstract : A 80 year old diabetic male presented to the General Medicine department at Amrita Institute of Medical Sciences, Cochin, Kerala, India in January 2013 with complaints of severe weight loss. Despite extensive haematological tests, Mantoux test and chest X-ray, cause of weight loss was uncertain. A whole body 18F FDG PET/CT (18Fluorine labelled Flurodeoxyglucose Positron emission computed tomography/computed tomography, Fig. 1) was done to look for occult malignancy or infection. PET/CT images showed abnormal FDG uptake in bilateral adrenal glands. CT guided biopsy confirmed minimal active adrenal inflammation. Histopathologically special staining methods [PAS (Periodic acid-Schiff) and Geimsa stains] revealed fungal spores and organisms, thus confirming bilateral adrenal histoplasmosis as the underlying cause of weight loss (Fig. 2). Patient received itraconazole 200 mg twice daily oral doses and showed clinical improvement within

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