PMID- 37723545
OWN - NLM
STAT- MEDLINE
DCOM- 20230920
LR  - 20230922
IS  - 1472-6823 (Electronic)
IS  - 1472-6823 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Sep 18
TI  - Unexpected exacerbation of cryptococcal meningitis after unilateral adrenalectomy 
      in a PMAH patient: a case report and literature review.
PG  - 199
LID - 10.1186/s12902-023-01457-5 [doi]
LID - 199
AB  - BACKGROUND: Primary bilateral macronodular adrenal hyperplasia (PMAH) combined 
      with infection by an opportunistic pathogen is complicated. Clinical evidence on 
      managing PMAH patients with infections by opportunistic pathogens is 
      insufficient. CASE PRESENTATION: A 66-year-old male was admitted with bilateral 
      adrenal masses and was diagnosed with PMAH. Fever and disturbance of 
      consciousness appeared after laparoscopic left adrenalectomy. Cryptococcal 
      meningitis was confirmed by cerebrospinal fluid (CSF) culture. The exacerbation 
      of his medical condition was suspected to result from immune reconstitution 
      inflammatory syndrome (IRIS), and he had been treated with antifungal therapy and 
      glucocorticoid replacement, but he responded poorly and eventually died of 
      multiorgan failure. We summarized the clinical observations of 12 Cushing's 
      syndrome (CS) patients infected by Cryptococcus. Seven out of nine patients who 
      were treated for cryptococcus infection before receiving CS survived, while three 
      patients treated for cryptococcus infection after CS treatment developed signs of 
      IRIS and eventually died. CONCLUSION: Cushing's syndrome, complicated with 
      cryptococcal infection, has a high mortality rate, mainly when IRIS emerges. 
      Carefully identifying the presence of the suspected infection, and controlling 
      cryptococcal infection before removing the culprit adrenals could be the rational 
      choice.
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Tan, Lu
AU  - Tan L
AD  - Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital 
      of Sichuan University, 37 GuoXue Lane, Chengdu, Sichuan, 610041, P. R. China.
FAU - Zhao, Lianling
AU  - Zhao L
AD  - Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital 
      of Sichuan University, 37 GuoXue Lane, Chengdu, Sichuan, 610041, P. R. China.
FAU - Tang, Guangmin
AU  - Tang G
AD  - Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, 
      Sichuan, 610041, P. R. China.
FAU - Ren, Yan
AU  - Ren Y
AD  - Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital 
      of Sichuan University, 37 GuoXue Lane, Chengdu, Sichuan, 610041, P. R. China.
FAU - Tian, Haoming
AU  - Tian H
AD  - Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital 
      of Sichuan University, 37 GuoXue Lane, Chengdu, Sichuan, 610041, P. R. China.
FAU - Chen, Tao
AU  - Chen T
AUID- ORCID: 0000-0002-8371-779X
AD  - Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital 
      of Sichuan University, 37 GuoXue Lane, Chengdu, Sichuan, 610041, P. R. China. 
      chentao@scu.edu.cn.
LA  - eng
GR  - 2017FZ0062/Sichuan Province Science and Technology Support Program/
GR  - ZYGD18022/West China Hospital, Sichuan University/
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20230918
PL  - England
TA  - BMC Endocr Disord
JT  - BMC endocrine disorders
JID - 101088676
SB  - IM
MH  - Male
MH  - Humans
MH  - Aged
MH  - *Meningitis, Cryptococcal/diagnosis/etiology
MH  - Adrenalectomy/adverse effects
MH  - *Cushing Syndrome/etiology/surgery
MH  - *Cryptococcosis
MH  - Adrenal Glands
PMC - PMC10506208
OTO - NOTNLM
OT  - Case report
OT  - Cryptococcal meningitis
OT  - Cushing's syndrome
OT  - Immune reconstitution inflammatory syndrome
OT  - Primary bilateral macronodular adrenal hyperplasia
COIS- The authors declare that they have no competing interests.
EDAT- 2023/09/19 00:43
MHDA- 2023/09/20 06:42
PMCR- 2023/09/18
CRDT- 2023/09/18 23:51
PHST- 2022/10/18 00:00 [received]
PHST- 2023/09/13 00:00 [accepted]
PHST- 2023/09/20 06:42 [medline]
PHST- 2023/09/19 00:43 [pubmed]
PHST- 2023/09/18 23:51 [entrez]
PHST- 2023/09/18 00:00 [pmc-release]
AID - 10.1186/s12902-023-01457-5 [pii]
AID - 1457 [pii]
AID - 10.1186/s12902-023-01457-5 [doi]
PST - epublish
SO  - BMC Endocr Disord. 2023 Sep 18;23(1):199. doi: 10.1186/s12902-023-01457-5.