Disseminated cryptococcosis involving the adrenal gland and brain in an immunocompetent patient: A case report

Rationale: Cryptococcosis is a fungal infection that primarily occurs in immunocompromised individuals. This infection typically affects the lungs and central nervous system, while adrenal involvement is relatively uncommon. Our research reports a rare case of adrenal cryptococcosis in a patient with normal immune function, with suspected involvement of the nervous system. Patient concerns: A 51-year-old male patient with normal immune function presented with progressive symptoms of dizziness, palpitations, and fatigue, which had persisted for 2 years. Imaging studies revealed a hypoechoic mass in the left adrenal gland, multiple intracranial lesions, and progressive hydrocephalus. The adrenal mass was initially suspected to be a tumor, but pathological examination following surgical resection confirmed a Cryptococcus infection. Despite normal endocrine and immune markers, central nervous system dissemination was strongly suspected based on the progressive changes observed on magnetic resonance imaging. The patient was treated with a combination of amphotericin B and flucytosine, leading to significant improvement in the neurological symptoms. Diagnoses: The diagnosis of adrenal cryptococcosis was confirmed through surgical pathology, and based on the results of cranial magnetic resonance imaging, it is considered that the adrenal cryptococcosis may be accompanied by potential involvement of the nervous system. Interventions and outcomes: After the diagnosis, a treatment plan was developed, and following treatment, the patient’s dizziness symptoms improved, leading to their subsequent discharge. Lessons: These results suggest that clinicians should broaden their diagnostic thinking by combining advanced imaging techniques with thorough clinical evaluation to enhance their diagnostic ability for adrenal cryptococcosis, thereby preventing missed or misdiagnoses and ensuring timely, accurate, and effective treatment to improve patient outcomes.