PMC8493109_01
CECT abdomen shows bilateral adrenal enlargement with the right (3 x 2 cm) and left (4 x 3 cm). Both the adrenals were heterogeneous, had irregular margins and calcifications.
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Computed tomography was done after stabilization showed bilateral adrenomegaly (Figure 1), with the size of the right and left adrenals, 3x2 cm ad 4x3 cm, respectively.
4 cm x 1.5 cm ulcer on the upper gum line, with a whitish coating over the ulcer.
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He had a linear ulcer of 4.0x1.5 cm on the upper anterior gingiva (Figure 2).
Anal region showing a 2.0x2.0-cm area of induration at the left lateral anus.
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He had an ulcer on the anal verge, covering 240 degrees on the verge (Figure 3).
Histologic features of perianal biopsy: (A) High power (1000x) of H&E-stained section demonstrates yeast of Histoplasma capsulatum; (B) High power (1000x) of PAS-stained section demonstrates a mononuclear inflammatory infiltrate composed of histiocytes, lymphocytes, and plasma cells along with Histoplasma capsulatum; (C) Low power (400x) of PAS-stained section shows histiocytes with intracytoplasmic fungal yeast forms (2-5 microm) with a characteristic halo.
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The Histoplasma capsulatum was confirmed by PAS positivity (Figure 4).