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The Great Mimicker or the Great Masquerader?

  • Marvin Wei Jie Chua
    Correspondence
    Requests for reprints should be addressed to Marvin Wei Jie Chua, MBBS (Singapore), MRCP (UK). Consultant, Endocrinology Service, Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886
    Affiliations
    Consultant, Endocrinology Service, Department of General Medicine, Sengkang General Hospital, Singapore
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Published:October 13, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.08.040
      Large adrenal masses with a diameter of ≥4 cm, although infrequently encountered, should prompt the consideration of 2 main diagnoses— pheochromocytoma and adrenal cortical carcinoma. In this report, I describe a patient who presented with shock and multiorgan failure, who was unexpectedly found to have a large adrenal mass on computed tomography (CT) scan, which was done for localization of infective foci. He had a stormy initial clinical course, and the possibility of pheochromocytoma crisis was considered, as “the great masquerader” can present in a myriad of ways. Blood cultures confirmed melioidosis, investigations excluded pheochromocytoma, and most significantly, this adrenal mass completely disappeared after 4 months of antibiotic therapy. This confirmed the diagnosis of disseminated melioidosis with adrenal gland abscess and is the first reported case of complete resolution of an adrenal abscess in melioidosis. This case is a reminder to all clinicians why melioidosis had earned its namesake “the great mimicker” and highlights the importance of a high index of suspicion for diagnosis.
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