Disseminated cryptococcosis causes adrenal insufficiency in an immunocompetent individual

Disseminated cryptococcosis infection occurs mainly in the immunocompromised host. There are only a few reports describing disseminated cryptococcosis in immunocompetent patients. Here, we describe the case of a 46-year-old healthy man who presented with primary adrenal insufficiency with hyponatremia, hyperkalemia and skin pigmentation. Contrast-enhanced adrenal computed tomography (CT) revealed bilaterally enlarged adrenal glands without enhancement. CT-guided percutaneous adrenal gland biopsy showed caseous-like necrosis and embedded cryptococcosis. The serum cryptococcal antigen titer was 1: 512. After ten months of fluconazole treatment, the serum cryptococcal antigen titer remained elevated at 1: 256 and contrast-enhanced adrenal magnetic resonance imaging revealed continued enlargement of bilateral adrenal glands without enhancement. The patient is currently on a therapeutic regimen of prednisolone, fludrocortisone and fluconazole and is scheduled for regular outpatient follow-up.