{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:03:14Z","timestamp":1779696194892,"version":"3.53.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":144,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In critically ill patients, critical illness\u2013related corticosteroid insufficiency (CIRCI) is an important cause of vasopressor\u2010refractory shock. However, distinguishing relative or functional CIRCI from structural adrenal insufficiency\u2014such as that caused by hemorrhagic adrenal necrosis\u2014can be challenging because their clinical presentations often overlap despite fundamentally different pathophysiological mechanisms. Cytomegalovirus (CMV) adrenalitis with hemorrhagic adrenal necrosis is rare, potentially fatal, and may be overlooked.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 70\u2010year\u2010old man with ischemic cardiomyopathy and diabetic nephropathy\u2013related chronic kidney disease, without known immunodeficiency, was admitted for acute decompensated right\u2010sided heart failure. He required intensive care and continuous renal replacement therapy for refractory right\u2010sided heart failure and renal failure. During his ICU stay, he experienced two episodes of vasopressor\u2010refractory shock. Although the random serum cortisol level was not unequivocally low, hydrocortisone was administered for clinically presumed CIRCI, resulting in transient hemodynamic improvement. After tapering and discontinuation of hydrocortisone, shock recurred and progressed despite treatment for presumed septic shock, and the patient died. Autopsy revealed extensive bilateral hemorrhagic adrenal necrosis. Microscopic examination demonstrated characteristic \u201cowl\u2032s eye\u201d intranuclear inclusions and positive CMV immunohistochemistry, consistent with CMV adrenalitis causing acute structural adrenal failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even in critically ill patients without apparent baseline immunodeficiency, secondary immunosuppression due to prolonged ICU care may facilitate CMV reactivation, leading to fatal adrenal insufficiency. This case highlights the importance of distinguishing presumed CIRCI from evolving structural adrenal failure and of considering CMV adrenalitis in prolonged ICU patients with recurrent shock.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crcc\/6331364","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:15:46Z","timestamp":1779693346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Autopsy\u2010Confirmed CMV Adrenalitis With Bilateral Adrenal Hemorrhage Following Presumed Critical Illness\u2013Related Corticosteroid Insufficiency During Prolonged ICU Stay: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1496-488X","authenticated-orcid":false,"given":"Yoko","family":"Kanamitsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-1850","authenticated-orcid":false,"given":"Yusuke","family":"Seino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsumi","family":"Toyoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Sugiura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Takano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kunishima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Izumo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-682X","authenticated-orcid":false,"given":"Shigeki","family":"Fujitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"e_1_2_13_1_2","first-page":"2078","article-title":"Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I) Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM). 2017","volume":"45","author":"Annane D.","year":"2017","journal-title":"Intensive Care Medicine"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1473151"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjac122"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1710"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra020529"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20210753"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.2022.J085"},{"key":"e_1_2_13_8_2","volume-title":"Chronically Critically Ill Population Payment Recommendations (CCIP-PR)","author":"Kandilov A. 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