J Korean Soc Endocrinol.  2004 Apr;19(2):217-222.

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

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea.
  • 2Department of Pathology, Kyungpook National University, School of Medicine, Daegu, Korea.
  • 3Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Korea.

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


MeSH Terms

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
Adrenocorticotropic Hormone
Hydrocortisone
Immunoglobulin M
Steroids
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