Primary Adrenal Lymphoma:

A case of primary bilateral adrenal lymphoma presenting as fever of unknown origin is reported. A 60-year-old man presented with constitutional symptoms and pain in the abdomen. Clinical evaluation and routine investigations, including complete hemogram and serum chemistry, were unremarkable. Serum lactate dehydrogenase and beta(2)-microglobulin were elevated. His basal and peak cortisol levels after 250 jig adrenocorticotrophin hormone stimulation were normal. Computed tomography of the abdomen revealed bilateral heterogeneously enhancing adrenal mass. A diagnosis of primary adrenal non-Hodgkin lymphoma (B cell type) was made after biopsy and exclusion of involvement by lymphomatous process at other sites. He was put on cyclophosphamide, doxorubicin, vincristine, prednisone-based combination chemotherapy. At the fourth cycle of chemotherapy, there was marked reduction in the size of tumors and he remained eucortisolemic. He lost to follow up and 2 months later reported to have died from the illness. Primary adrenal lymphoma, although a rare entity, should be suspected in all patients with fever and bilateral adrenal enlargement even if adrenal insufficiency is not present.