DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.036

Pages: 471-474

Acute adrenal insufficiency is a rare but life-threatening endocrine emergency that may result from bilateral adrenal hemorrhage. Its association with Epstein–Barr virus (EBV) infection is exceptional. We report the case of a 30-year-old man with no significant medical history who was admitted for severe diffuse abdominal pain, vomiting, diarrhea, and persistent hypotension. Laboratory investigations revealed severe hyponatremia, hyperkalemia, thrombocytopenia, elevated inflammatory markers, and markedly decreased serum cortisol levels. Immediate intravenous hydrocortisone therapy was initiated. Imaging studies showed bilateral adrenal enlargement on computed tomography, and magnetic resonance imaging confirmed subacute bilateral adrenal hemorrhage. Extensive etiological investigations excluded autoimmune, coagulation, and other infectious causes. EBV serology demonstrated positive IgG with negative IgM, suggesting past infection or viral reactivation. The patient showed favorable clinical and biochemical improvement under corticosteroid replacement therapy. This case highlights the importance of considering bilateral adrenal hemorrhage in cases of unexplained acute adrenal insufficiency and underscores EBV infection as a rare but possible infectious trigger.