Progressive gastrointestinal histoplasmosis leading to colonic obstruction two years after initial presentation

Hertan, Hilary; Nair, Satheesh; Argüello, Pedro

doi:10.1111/j.1572-0241.2001.03479.x

Cited by 20 publications

(20 citation statements)

References 5 publications

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“…The organism is transmitted by inhalation of spores from soil contaminated by bat or bird droppings. [3][4][5][6] Clinical manifestations of gastrointestinal histoplasmosis range from none, in asymptomatic infection, to nausea, vomiting, diarrhea, bleeding, abdominal pain, weight loss, obstruction, and perforation. Indeed, Goodwin and colleagues noted two decades ago that "the diagnosis of histoplasmosis begins with thinking of it."…”

mentioning

confidence: 99%

The Unturned Stone

Goulet

Moseley²,

Tonnerre

et al. 2005

N Engl J Med

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n engl j med 352;5 www.nejm.org february 3, 2005The new england journal of medicine 489 clinical problem-solvingIn this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.A 20-year-old man was transferred to an academic medical center in Salt Lake City for further evaluation of diarrhea, abdominal pain, and fever. Two months before admission, he presented to a community hospital with dull, intermittent pain in the right lower quadrant. A colonoscopy performed at that time showed patchy erythema, edema, and ulcerations from the transverse colon to the cecum. The terminal ileum also appeared inflamed and had linear ulcerations. Pathological examination of specimens revealed nonspecific chronic inflammation.The patient's symptoms have been present for two months, defining this as a case of chronic diarrhea. Acute diarrhea, most often caused by infectious agents, resolves within four weeks. Among the four major categories of chronic diarrhea -osmotic, secretory, fatty, and inflammatory -the fever and endoscopic and pathological findings point to an inflammatory process. Disorders to consider include Crohn's disease, Behçet's disease, and chronic infections such as gastrointestinal tuberculosis, histoplasmosis, and amebiasis. Ulcerating viral infections (such as cytomegalovirus and herpes simplex infection) would be important concerns in an immunocompromised patient.While at the community hospital, the patient tested positive for Clostridium difficile toxin, but did not improve despite treatment with oral metronidazole and, subsequently, oral vancomycin. He was also treated aggressively for presumed Crohn's disease with mesalamine, corticosteroids (prednisone, 60 mg daily), and two infusions of infliximab -with no improvement. Because of increasing pain and abdominal distention, the patient was placed on total parenteral nutrition and transferred to the academic medical center for further management of his condition.

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confidence: 99%

The Unturned Stone

Goulet

Moseley²,

Tonnerre

et al. 2005

N Engl J Med

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“…However in patients with impaired cellular immunity, the infection can disseminate to various organs and is known as progressive disseminated histoplasmosis (PDH). The GI tract is involved in up to 90% cases of PDH, however, specific GI features are uncommon 2–5. Terminal ileum and cecum are most frequently involved sites3 and endoscopic findings include plaques, polyps, mucosal oedema, ulcerations, strictures and masses 2 5…”

Section: Discussionmentioning

confidence: 99%

Disseminated histoplasma and CMV infection presenting as subacute intestinal obstruction in an immunocompromised patient

Shahani

2012

Case Reports

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“…[4–7] A previous report highlighted the fact that intestinal histoplasmosis can progress to complicated lesions, including strictures, despite adequate medical management. [8] The recommended treatment for histoplasmosis is liposomal for two weeks followed by long-term oral itraconazole treatment (200mg, twice daily). It is also pertinent to note that endoscopic persistence of histoplasma organisms on histology despite negative cultures has been noted in the literature, which supports the need for long-term itraconazole therapy.…”

Section: Discussionmentioning

confidence: 99%

“…It is equally important to educate patients about complications of intestinal obstruction despite being on adequate treatment. [8]…”

Section: Discussionmentioning

confidence: 99%

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

Panchabhai

Bais²,

Pyle

et al. 2011

J Global Infect Dis

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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.

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Progressive gastrointestinal histoplasmosis leading to colonic obstruction two years after initial presentation

Cited by 20 publications

References 5 publications

The Unturned Stone

The Unturned Stone

Disseminated histoplasma and CMV infection presenting as subacute intestinal obstruction in an immunocompromised patient

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

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