LBODP007 Clinical Characteristics And Treatment Outcomes Of Adrenal Histoplasmosis And Tuberculosis In Thailand: A 15-year Retrospective Study In A Single Tertiary Center

Abstract

Abstract Background Adrenal histoplasmosis and tuberculosis (TB) are the most common adrenal infections. These conditions are widely reported in developing countries. Methods We performed a retrospective study of patients with adrenal histoplasmosis and TB at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from 2005 to 2020, and evaluated clinical characteristics, treatment, and outcomes. The diagnosis was made by proven microbiologic evidence of infection and morphologic adrenal abnormalities by cross-sectional imaging. Results Of all 27 patients, 20 had adrenal histoplasmosis, 6 had adrenal TB, and 1 had coinfection with both pathogens. The majority of the patients had bilateral adrenal involvement (93%). Most patients were males (81%), and the mean age was 62 years. Ninety-six percent of patients did not have HIV infection. The most frequent comorbidities were hypertension (50%) and diabetes mellitus (23%). Common presentations were weight loss and anorexia (77%), and fever (65%), in which the median time from the presentation to diagnosis was 3.5 months. The prevalence of adrenal insufficiency was 67%. All patients with adrenal insufficiency received steroid replacement, yet 17% had an adrenal crisis during the treatment course. Ninety-six percent of patients received medical treatment (antituberculosis or antifungal agents), while almost half needed additional surgery (44%). During a median follow-up period of 20.5 months, the mortality rates were 28.5%, in which all death was from patients with adrenal histoplasmosis or coinfection with histoplasmosis and TB. Conclusion There were high rates of adrenal insufficiency in patients with adrenal histoplasmosis and TB. High mortality rates were also observed, particularly in adrenal histoplasmosis. Appropriate management of these conditions is required from both infectious and hormonal perspectives. Presentation: No date and time listed