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Article in Japanese

Adrenal crisis in patient with hypopituitarism due to Salmonella infection diagnosed with blood cultures with repetition; a case report

Takeshi ISHIMI1), Takehisa YAMAMOTO1), Motoaki NITTA1), Junji AZUMA1), Yoshimi MIZOGUCHI1), Tsunesuke SHIMOTSUJI1)

We presented a 21-year-old male occurred adrenal crisis due to a non-typhoidal Salmonella O8 infection. His illness was diagnosed as panhypopituitarism at the age of 2 years and he received adrenal steroid replacement therapy. On the first visit of this event, he visited our hospital due to fever, nausea and watery diarrhea. We found hypoglycemia and hypotension. Thus, we diagnosed his illness as adrenal crisis and administered him intravenous hydrocortisone. However, it was difficult to decrease hydrocortisone in dosage due to prolonged symptoms of adrenal insufficiency.
On the other hand, we did not detect notable bacterial infection by blood and stool culture tests and then we did not administer any antibiotics. However, high fever and nausea persisted, we performed culture test after increasing of blood volume and the number of bottles tested. We found Salmonella O8 from his blood culture on the 8th hospital day and then we administered him antibiotic agents. He had gradually improved and was discharged at the 22th hospital day.
When a patient with central hypoadrenocorticism as the underlying disease develops an adrenal crisis due to a gastrointestinal infection, it is important to administer early antibacterial drugs with bacteremia in mind.

1) Department of Pediatrics, Minoh City Hospital

Key words Panhypopituitarism, blood culture, adrenal crisis, non-typhoidal Salmonella O8 infection
Received August 21, 2018
Accepted October 1, 2019

32 (1):27─32,2020