CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 July-August;172(7-8):659-62

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

An unusual presentation of tuberculosis as acute adrenal failure. Case report and review of the literature

Shiber S. ¹, Shtiemetz T. ¹, Gafter-Gvili A. ^{1, 2}, Leibobici L. ^{1, 3}

¹ Department of Internal Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel 2 Institute of Hematology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel; ³ Unit of Infectious Diseases, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel

A 80-year-old man was admitted to our hospital complaining of weakness, headache and nausea. The clinical picture was compatible with primary Addison’s disease due to the combination of low blood pressure, weight loss, fatigue and hyperpigmentation. Corticotropin test affirmed the diagnosis and his condition improved rapidly with the administration of hydrocortisone and fluids. Abdominal CT scan revealed 4.4×2.4 cm size mass with heterogenic enhancement in the right adrenal. In the left adrenal there was 2.2×1.4 cm size mass with similar characteristics. The biopsy revealed granuloma with caseating necrosis, suggestive of tuberculosis adrenalitis. The patient treated with a full regimen for tuberculosis with full recovery.