新型隐球菌感染导致肾上腺皮质功能减退症1例报告并文献复习

Adrenocortical insufficiency caused by Cryptococcus neoformans:a case report and literature review

目的探讨肾上腺隐球菌病的临床特征、诊断和治疗方案,以提高临床医师对该疾病的认识。方法分析本院2022年6月收治的1例新型隐球菌感染导致肾上腺皮质功能减退患者的临床表现、检验指标、影像学资料、术后病理结果,并结合相关文献复习。结果本例患者出现头晕、乏力症状,全身多处色素沉着,2022年6月24日上腹部平扫CT提示双侧肾上腺多发结节状软组织影,2022年7月1日上腹部增强CT提示双侧肾上腺结节呈轻度不均匀强化,考虑肾上腺肿瘤可能性大,遂于2022年7月13日行后腹腔镜下右侧肾上腺部分切除术,术后病理提示隐球菌病。术后予伊曲康唑抗真菌治疗2周后自行停用,术后3个月复查CT提示双侧肾上腺多发占位,再次服用伊曲康唑治疗。结论肾上腺隐球菌病患者通常出现头晕、乏力、全身多处色素沉着等肾上腺皮质功能减退的症状,腹部增强CT通常表现为肾上腺结节伴不均匀强化。确诊需要依靠病理学检查,治疗上可考虑行肾上腺切除术,术后给予抗真菌治疗。

Objective To explore the clinical features,diagnosis and treatment regimen of adrenal cryptococcosis so as to improve awareness of this disease for clinicians.Methods The clinical manifestations,laboratory indicators,imaging data and postoperative pathological results of a patient with adrenocortical insufficiency caused by Cryptococcus neoformans infection admitted to our hospital in June 2022 were collected and analyzed,and the related literature was reviewed.Results This patient presented with dizziness,fatigue,and multiple pigmentations throughout the whole body.Upper abdominal plain CT scan on June 24,suggested multiple nodular soft tissue shadows in the bilateral adrenal glands,and the scan on July 1 suggested mild inhomogeneous enhancement of bilateral adrenal nodules,which may be adrenal tumors.Retroperitoneal laparoscopic partial adrenalectomy was performed on July 13.Postoperative pathology indicated cryptococcosis.The antifungal treatment with itraconazole was stopped after 2 weeks by himself.In 3 months after the operation,CT revealed multiple adrenal masses on both sides,and itraconazole was taken again for treatment.Conclusion Patients with adrenal cryptococcosis usually have symptoms of adrenocortical insufficiency such as dizziness,fatigue,and multiple pigmentations throughout the whole body.Abdominal enhanced CT usually indicates adrenal nodules with inhomogeneous enhancement.The diagnosis depends on pathological examination,and antifungal therapy can be considered after adrenalectomy.