Disseminated Adrenal Histoplasmosis Revealing Previously Undiagnosed Multiple Myeloma: A Rare Case Report

Background: Histoplasmosis is an opportunistic fungal infection caused by *Histoplasma capsulatum*, typically occurring in immunocompromised individuals. Adrenal involvement is uncommon but may lead to adrenal insufficiency. Multiple myeloma is a plasma cell malignancy that causes immune dysfunction even before therapy begins. Coexistence of untreated multiple myeloma and adrenal histoplasmosis is extremely rare. Case Presentation: We report a case of a 60-year-old male presenting with weight loss, fatigue, hypotension and fever. Investigations revealed bilateral adrenal masses and a diagnosis of multiple myeloma, with no biochemical evidence of adrenal insufficiency. Comprehensive diagnostic work-up included imaging studies, serological tests, laboratory examinations, bone marrow aspiration and biopsy studies and histopathological examination of adrenal gland biopsy which confirmed the diagnosis of histoplasmosis; fungal culture and urinary *Histoplasma* antigen were also positive. The patient was started on liposomal amphotericin B but expired before completion of therapy.Conclusion: Adrenal histoplasmosis may be the initial manifestation of underlying immunosuppression in patients with previously undiagnosed or untreated multiple myeloma. This rare association emphasizes the need for thorough infectious evaluation in such patients.