A Case of Adrenal Cryptococcosis Removed by Laparoscopic Adrenalectomy

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  • 腹腔鏡下に摘出した副腎クリプトコッカス症の1例
  • 症例 腹腔鏡下に摘出した副腎クリプトコッカス症の1例
  • ショウレイ フククウキョウ カ ニ テキシュツ シタ フクジン クリプトコッカスショウ ノ 1レイ

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Abstract

Cryptococcosis is an opportunistic infection that rarely develops in healthy individuals. Cryptococcosis is acquired by inhalation of soil contaminated with the fungus Cryptococcus. Accordingly, cryptococcosis usually affects the lungs, and it rarely spreads hematogenously to the adrenal glands. The current authors encountered a case of adrenal cryptococcosis where the patient concerned had no underlying condition and no apparent pulmonary lesions. The patient was a 66-year-old man who presented with a fever of unknown origin and was initially seen at the Department of Internal Medicine in our hospital a year and a half previously. Further testing was performed, and a CT scan incidentally revealed a mass 23 mm in diameter on the right adrenal gland. Subsequent examination indicated that the mass was a non-functioning adrenal tumor, so the tumor had been followed thereafter by periodic examinations. A CT scan performed a year and a half later revealed that the tumor had enlarged to 38 mm in diameter. The patient was then referred to our department. We performed laparoscopic right adrenalectomy, and pathological findings indicated cryptococcosis involving the right adrenal gland. Cerebrospinal fluid was tested after the surgery and cryptococcal meningitis was diagnosed. Treatment with an antifungal agent was begun, and the patient visited our clinic periodically to measure his Cryptococcus antibody titer and cryptococcal antigen levels. The patient's antibody titer and antigen levels gradually decreased, and the antifungal regimen was terminated about a year and a half postoperatively.

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