Case 13-2025: A 70-Year-Old Man with Weight Loss, Weakness, and Anorexia
Abstract
- This Case Records of the Massachusetts General Hospital article presents the evaluation of a 70-year-old man with a 6-week history of anorexia, dysgeusia, profound fatigue, and 13.6 kg weight loss. Imaging revealed a left adrenal nodule. Laboratory studies showed hypokalemia, hyperglycemia, thrombocytopenia, and lymphopenia. He developed progressive encephalopathy with abnormal cerebrospinal fluid (CSF) findings: elevated opening pressure, hypoglycorrhachia, and mild pleocytosis. A jigsaw-puzzle diagnostic approach led to the identification of Cushing’s syndrome, confirmed by markedly elevated urinary cortisol. Positive cultures for Cryptococcus neoformans in blood and CSF confirmed cryptococcal meningitis. Despite antifungal therapy, the patient developed cerebral edema and herniation and passed away. The case underscores how hypercortisolism-induced immunosuppression may predispose to life-threatening opportunistic infections, even in the absence of HIV
Keywords:
Cushing’s syndrome
cryptococcal meningitis
adrenal nodule
CSF analysis
encephalopathy
opportunistic infection
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