Bilateral adrenal masses as the sole clinical key for diagnosing a Histoplasma capsulatum infection.

We describe a case of a 52-year-old man presenting with bilateral adrenal masses. A Histoplasma capsulatum infection was diagnosed on the basis of culture, pathological findings, Histoplasma antigen detection and molecular testing. The patient was treated with itraconazole and initially showed a good response. However, after discontinuation of one year of therapy, a relapse was seen and therapy was restarted. This case illustrates that histoplasmosis should be considered in the differential diagnosis of patients presenting with bilateral adrenal enlargement. Of all the diagnostic tests that are available, serology and antigen detection are the only rapid and non-invasive tests. Antigen detection can also be used for further follow-up of the disease.