Abstract
Lymphohematogenous spread of mycobacterium tuberculosis to multiple organs presents a complex diagnostic challenge to any physician. A holistic and vigilant approach is required in the quest to diagnose disseminated tuberculosis causing adrenal failure. Although tuberculosis can affect various endocrine glands of the body yet adrenal remains the most common.[1] It is also the fifth most common site for extra-pulmonary tuberculosis.[2] The incidence of tuberculous Addison’s disease has lowered courtesy of anti-tubercular medications accounting for only 7-20% of cases.[1] Here we showcase a rare incidence where a 39 years old gentleman with no constitutional symptoms and no known co-morbidities presenting with neck pain went into adrenal crisis and eventually was found to be due to disseminated tuberculosis which affected his lungs, adrenal glands, cervical spine, and brain.
Highlights
Primary adrenal failure is a life-threatening medical emergency that requires immediate attention
We present a case of a 65-year-old gentleman with no previously known co-morbidities presenting to the emergency unit with a week’s history of neck pain and dizziness
Subsequent chest imaging showed miliary mottling and a suprarenal CT with contrast demonstrated bi-lateral adrenal masses which was later confirmed by CT guided FNAC to have appearances consistent with adrenal tuberculosis
Summary
Primary adrenal failure is a life-threatening medical emergency that requires immediate attention. We present a case of a 65-year-old gentleman with no previously known co-morbidities presenting to the emergency unit with a week’s history of neck pain and dizziness. He was admitted under the orthopedic team but later during the course of hospital admission, collapsed in the hospital leading to the involvement of the medical team. Spine and brain imaging tests found the presence of tuberculoma. He was treated with simultaneous anti-tubercular therapy and adrenal hormone replacement therapy
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