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Reversal of Adrenal Glucocorticoid Dysfunction in a Patient with Disseminated Histoplasmosis

Ronald G. Washburn, MD; and John E. Bennett, MD
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Requests for Reprints: Ronald G. Washburn, MD, Department of Medicine, Bowman Gray School of Medicine, 300 S. Hawthorne Road, Winston-Salem, NC 27103.

Current Author Addresses: Dr. Washburn: Department of Medicine, Bowman Gray School of Medicine, 300 S. Hawthorne Road, Winston-Salem, NC 27103.

Dr. Bennett: Room UN 107, Building 10, National Institutes of Health, Bethesda, MD 20892.

Ann Intern Med. 1989;110(1):86-87. doi:10.7326/0003-4819-110-1-86
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Disseminated histoplasmosis frequently affects the adrenal cortex (1, 2); involvement may range from asymptomatic inflammation of cortical sinusoids with parasitized macrophages (1, 3) to extensive necrosis resulting in potentially fatal Addison disease (1, 2, 4-8). In most reported cases with clinically apparent adrenocortical dysfunction, the assumption was made that tissue destruction was complete and permanent, necessitating lifelong steroid replacement. We report a case of disseminated histoplasmosis in which severely compromised adrenal glucocorticoid function returned to normal after a prolonged course of antifungal chemotherapy with ketoconazole.

A previously healthy 63-year-old black woman noted pruritus over the left vulvar area in January


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