An apple-core lesion in the colon: An infectious etiology

Abstract

Gastrointestinal involvement occurs in about 70% to 90% of histoplasmosis cases but is usually not the initial manifestation. We present the case of a 52-yearold HIV-positive woman who presented with gastrointestinal symptoms and an apple-core lesion on CT scan of the abdomen. The patient had been diagnosed with histoplasma colitis eight months earlier and was started on long-term itraconazole therapy. However, she prematurely discontinued treatment. A colonoscopy during the present hospitalization revealed a 3.5-cm mass, biopsies of which revealed Histoplasma capsulatum. In the present report, we discuss the differential diagnosis of apple-core lesions in the colon and the importance of keeping histoplasmosis on the differential diagnosis, especially in endemic areas like the Ohio River valley. It is equally important to ensure compliance with treatment of histoplasmosis, as well as close follow-up, as progression to colonic obstruction while on medical management has been reported.

Apple-core Lesion of Colon Adenocarcinoma by Barium Double Contrast Enema

“…The apple-core lesion of colon may be caused by a variety of diseases, such as adenocarcinoma [1,2], ischaemic colitis [3], infection [4,5], inflammatory colitis [6], endometriosis [7], and sequela of radiotherapy treatment [8]. Severe colonic lumen narrowing leads to bowel obstruction [9,10].…”

A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract

“…Histoplasmosis is a saprophytic dimorphic fungus that grows as a mold in the environment and yeast in physiological tissue and culture media [ 36 ]. It is present worldwide and is endemic to the Mississippi and Ohio River valleys in the USA.…”

“…GI involvement is present in 70-90% of disseminated cases but is not always the initial manifestation [ 36 ]. Common symptoms include fever, weight loss, abdominal pain, distention, and, most importantly, hepatosplenomegaly.…”

“…The most frequently infected site is the ileocecal junction secondary to the abundance of lymphoid aggregates in this region. This is then followed by the colon and, occasionally, the small intestine and upper GI tract [ 36 ]. Regional lymphadenopathy is a frequent theme in these affected sites and is often present in almost all cases of Histoplasmosis [ 36 , 39 ].…”

“…This is then followed by the colon and, occasionally, the small intestine and upper GI tract [ 36 ]. Regional lymphadenopathy is a frequent theme in these affected sites and is often present in almost all cases of Histoplasmosis [ 36 , 39 ]. Recently, four distinct pathologies have been described [ 36 ]: subclinical and microscopic clusters of macrophages localized in the lamina propria; plaques and pseudo polyps resulting from fungi containing macrophages; tissue necrosis and ulcerative lesions causing clinical manifestations such as abdominal pain, diarrhea, and bleeding; and localized thickening and acute inflammation of the bowel, consequently mimicking CD.…”