Intestinal histoplasmosis in immunocompetent patient: An unusual cause of massive small intestine bleeding

Abstract

Small bowel bleeding (SBB) accounts for 5-10% of patients with gastrointestinal bleeding and its association is unusual in patients with histoplasmosis. The incidence of gastrointestinal histoplasmosis is unknown since only 3-12% present symptoms, predominantly in immunocompromised patients. However, in immunocompetent hosts, it is reported only in 0.05% of cases. A clinical case of an immunocompetent patient with massive SBB, Grade IV hypovolemic shock associated with systemic histoplasmosis and treated with intestinal resection and amphotericin B is hereby discussed.

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

“…As a result of delay, some patients experienced worsening clinical states [ 33 , 69 , 89 , 105 , 107 , 116 ] and/or death [ 20 , 80 , 100 , 116 , 122 ]. A high index of suspicion in evaluating GIH in patients is needed as this will reduce the incidence of complications, such as lower gastrointestinal bleeding [ 17 , 26 , 27 , 29 , 30 , 31 , 33 , 39 , 44 , 53 , 56 , 59 , 63 , 70 , 84 , 94 , 102 , 103 , 105 , 110 , 119 ], intestinal perforation [ 54 , 73 , 80 , 111 ], ulceration [ 70 , 102 , 103 ], intestinal obstruction [ 15 , 21 , 50 , 57 , 81 , 89 , 95 , 102 , 103 , 104 , 117 ], acute pancreatitis [ 20 , 65 , 75 , 115 ], acute cholecystitis [ 44 , …”

“…DH with gastrointestinal bleeding due to gastrointestinal involvement is rare [ 70 ]. It is seen twice as frequently in HIV/AIDS patients compared with immunocompetent patients [ 7 ].…”

“…Focusing on cases without HIV infection, the findings from our review suggest the need to also evaluate patients without HIV infection with risk factors for GIH including post-transplant patients on immunosuppressants [ 16 , 39 , 46 , 49 , 61 , 62 , 63 , 72 , 84 , 101 , 113 ], patients on immunosuppressants for other disease conditions [ 14 , 15 , 17 , 20 , 25 , 28 , 30 , 69 , 76 , 92 , 103 , 105 ] and patients with immunodeficiency syndrome [ 95 ] presenting with GI symptoms. This should be done regardless of the immune status of an individual as complications associated with GIH, such as acute abdomen [ 70 ], can also develop in immunocompetent patients. Unfavourable outcomes were mainly seen in cases with HIV infection and those receiving amphotericin B deoxycholate monotherapy, and most likely reflect a delayed and more severe clinical disease presentation.…”