Introduction: The adrenal gland is an uncommon site for infection such as extrapulmonary tuberculosis (TB). In most cases, TB of the adrenals involve both glands however it may also occur rarely as unilateral. At present there are only few data reported with unilateral adrenal TB.

Case Presentation: We report a case of unilateral adrenal tuberculosis seen in a 39-year-old female who presented with weight loss, abdominal pain, diarrhea, and bloatedness. On Physical Examination, patient was noted to have temporal wasting and tenderness on all quadrants of the abdomen. Whole abdominal Computed Tomography scan with contrast was done and revealed an enhancing, noncalcified, non-hemorrhagic left adrenal mass measuring 3.6x1.7x4.9cm, and peritoneal carcinomatosis. TB Gold Quantiferon requested was positive. She underwent CT guided biopsy of adrenal mass and peritoneal carcinomatosis with findings consistent of tuberculosis. The Patient was started with an anti-TB regimen for 6 months. On follow up, her gastrointestinal signs and symptoms resolved with noted weight gain.

Conclusion: Unilateral adrenal mass is mostly associated with primary tumors of the adrenal glands, however further investigation to rule out infectious processes must be done among patients who has with history of travel or living in high burden countries for TB Delayed identification of tuberculosis and initiation of treatment could result in the progressive destruction of the adrenal glands and subsequent adrenal insufficiency.

Key words: Tuberculosis, Adrenal gland, Unilateral

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