Tuberculous adrenal abscess revealed by pleurisy: An extremely rare presentation: About a case

Abstract

We report an extremely rare presentation of a tuberculous adrenal abscess discovered accidently during a chest CT scan. This case involves a 21-year-old male patient with pleurisy and a left adrenal abscess simultaneously of tuberculous origin, without clinical or biological signs of adrenal insufficiency. The condition showed complete regression of the abscess after medical treatment. The aim of our work is to report an extremely rare case of adrenal tuberculosis in its abscessed form, to describe the imaging aspect in order to facilitate the diagnosis for radiologists.

Guarantor of submission

The corresponding author is the guarantor of submission.

1 Introduction

Adrenal masses discovered incidentally through imaging (incidentalomas) occur in 0.35 %–5 % of cases. They present a real diagnostic challenge given the absence of a typical appearance. The aetiologies are numerous: pheochromocytoma, adrenaloma, metastasis, tubercular adrenalitis …. The significance of our report is to emphasize that a tuberculous abscess and adrenal involvement by Mycobacterium tuberculosis should be considered among the differential diagnoses for any incidentaloma.

2 Case report

We report the case of a 21-year-old male patient, with no notable medical history, especially no recent allergy or infection, no surgical history, issued from a non-consanguineous marriage. The parents are healthy with no notable history of illness. He presented with a significant deterioration of general health, weight loss, low-grade nocturnal fever, and a persistent cough for three months. Biology showed a non-specific inflammatory syndrome with C-reactive protein at 354mg/ml. The rest of the workup was unremarkable, in particular the absence of signs of adrenal insufficiency. For persistent coughs A thoracic CT scan was performed, revealing a large, loculated left pleural effusion ans at the level of the abdominal sections performed, a mass in the left adrenal region was discovered. Further evaluation with an abdominal MRI revealed a thick-walled fluid collection in the adrenal region ( Fig. 1 A, 1B, 1C, 1D) . This mass enhances after injection, containing multiple septa and areas of necrosis. This collection measured 50 × 92 × 132 mm ( Fig. 1 E). Aspiration and drainage of the pleural effusion revealed Koch’s bacilli. The patient was placed on anti-tubercular treatment for 9 months. Follow-up at the end of treatment showed complete regression of the adrenal abscess. No resistance or side effects from the treatment were observed.