Gastrointestinal Histoplasmosis: A Case Series

Abstract

Histoplasmosis is an invasive mycosis caused by inhalation of the spores of dimorphic fungi Histoplasma capsulatum. The disease manifests in the lung as acute or chronic pulmonary histoplasmosis and in severe cases gets disseminated in multiple organs like skin, adrenal gland, central nervous system, lymph node, liver, spleen, bone marrow, and gastrointestinal tract. It occurs most commonly in immunodeficient patients like HIV-positive patients and transplant recipients, while immunocompetent hosts are affected rarely. In cases of gastrointestinal histoplasmosis, the samples are collected for culture and biopsy should be sent for histopathological examination for definitive diagnosis. We conducted a retrospective study of colonic biopsies performed in the department of gastroenterology in a tertiary care hospital of north India from January 2014 to December 2015. Five cases of colonic histoplasmosis were diagnosed on histopathology out of which 4 patients were from north India while 1 patient was from Myanmar. The patients presented with various complaints, including loose stools, diarrhea, altered bowel habits, and gastrointestinal bleeding. The prognosis is very good after early and aggressive treatment while the disease is fatal if it remains untreated. In our study, 2 patients died within few days of diagnosis due to delay in the diagnosis, dissemination, and associated complications. Other patients were started on amphotericin B deoxycholate and are under follow-up. An early diagnosis of gastrointestinal histoplasmosis is important as appropriate treatment leads to long-term survival while untreated cases are almost fatal.

A Rare Case of Hepatic Sarcoidosis Caused By Hepatitis B Virus and Treatment-Induced Opportunistic Infection

“…In addition to that, our patient had colonic histoplasmosis on steroid treatment for sarcoidosis [12]. It is well-known that immune-suppressive conditions predispose for histoplasmosis.…”

Disseminated histoplasmosis presenting as pyoderma gangrenosum‐like ulcers in an apparently immunocompetent patient: multiple red herrings presenting a diagnostic challenge

“…There are only a few reports of osteolytic lesions mimicking malignancy, as in our case 5,6 . Gastrointestinal involvement, reported to occur in 70–90% of patients in autopsy studies, is symptomatic in only 3–12% of cases and shows nonspecific findings on colonoscopy 7 . A diagnosis of GPA was later considered with the new‐onset palatal perforation, keratitis, maxillary sinusitis, a previously noted saddle nose deformity, and granulomatous inflammation in an earlier skin biopsy 8 .…”

Typical imaging finding of hepatic infections: a pictorial essay

“…Histoplasmosis is caused by inhalation of Histoplasma capsulatum spores. It usually develops in immunodeficient patients, such as HIV-positive patients and transplant recipients [39]. The liver is rarely the primary site of infection but it is often involved in the course of a progressive disseminated disease, which usually originates in the lungs or upper respiratory tract.…”