A 70-Year-Old Man with Weight Loss, Weakness, and Anorexia
Abstract
This diagnostic case study describes a 70-year-old man with a 6-week history of progressive anorexia, fatigue, and weight loss, followed by encephalopathy. His medical history included depression, gastric bypass surgery, and a remote history of hairy-cell leukemia. Initial findings included an indeterminate adrenal nodule, skin thinning, hypokalemia, and hyperglycemia. He later developed fulminant encephalopathy, and cerebrospinal fluid analysis revealed markedly abnormal findings: high opening pressure, hypoglycorrhachia, and neutrophilic pleocytosis. Blood cultures isolated Cryptococcus neoformans, and CSF culture confirmed cryptococcal meningitis. A markedly elevated 24-hour urinary cortisol level confirmed Cushing’s syndrome, likely contributing to immune suppression. Despite antifungal treatment, the patient experienced cerebral edema and died. The case illustrates the intersection of subclinical hypercortisolism and opportunistic infection.
Keywords:
cryptococcal meningitis
Cushing’s syndrome
encephalopathy
adrenal nodule
hypercortisolism
opportunistic infection
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