A Case of Acute Adrenal Insufficiency with Bilateral Adrenal Hemorrhagic Infarction due to Ebstein-Barr Virus Infection in a Patient with Asymptomatic Chronic Adrenal Insufficiency.
- Author:
Sung Chang CHUNG
1
;
Soon Hong PARK
;
Joo Young LEE
;
Shin Won LEE
;
Gui Hwa JEONG
;
Sun Zoo KIM
;
Han Ik BAE
;
Hun Kyu RYEOM
;
Jung Guk KIM
;
Young Oh KWEON
;
Sung Woo HA
;
Bo Wan KIM
Author Information
1. Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea.
- Publication Type:Case Report
- Keywords:
Acute adrenal insufficiency;
Ebstein-Barr virus (EBV);
Adrenal hemorrhagic infarction
- MeSH:
Adrenal Glands;
Adrenal Hyperplasia, Congenital;
Adrenal Insufficiency*;
Adrenocorticotropic Hormone;
Adult;
Antiphospholipid Syndrome;
Biopsy, Fine-Needle;
Epstein-Barr Virus Infections;
Headache;
Herpesvirus 4, Human;
HIV;
Humans;
Hydrocortisone;
Hyperpigmentation;
Immunoglobulin M;
Infarction*;
Lymphocytosis;
Myalgia;
Mycobacterium tuberculosis;
Pharyngitis;
Polymerase Chain Reaction;
Steroids;
Weight Loss
- From:Journal of Korean Society of Endocrinology
2004;19(2):217-222
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Acute adrenal insufficiency may result from adrenal crisis, hemorrhagic destruction, or the rapid withdrawal of steroids from patient with chronic steroid medication, congenital adrenal hyperplasia or those on other drugs. Acute hemorrhagic destruction of both adrenal glands can occur due to infection, trauma, anticoagulant therapy, antiphospholipid syndrome or a coagulation disorder. However, there have been no reports on acute hemorrhagic adrenal insufficiency due to the Ebstein-Barr virus (EBV). Herein, a case of acute adrenal insufficiency, with bilateral adrenal hemorrhagic infarction, is reported in a patient with asymptomatic chronic adrenal insufficiency. A 42-year-old man presented with general weakness, weight loss and hyperpigmentation of several months duration. He suffered from a sore throat, general myalgia and a headache on admission. The laboratory findings were lymphocytosis, positive EBV IgM antibody, low cortisol level and a high level of adrenocorticotropic hormone (ACTH). Adrenocortical autoantibody and PCR for Mycobacterium tuberculosis showed negative findings. The serologic findings for CMV and HIV were negative. Fine needle aspiration of the adrenal gland revealed a hemorrhagic infarction and positive staining for the anti-EBV antibody. Acute adrenal insufficiency was then diagnosed with a bilateral adrenal hemorrhagic infarction due to the EBV infection in the patient, also with asymptomatic chronic adrenal insufficiency. This is the first case of acute adrenal insufficiency with bilateral hemorrhagic infarction, due to an EBV infection
