Small intestinal histoplasmosis: successful treatment with itraconazole in an immunocompetent host

Bodily, K.; Perfect, John R.; Procop, Gary W.; Washington, Mary Kay; Affronti, John

doi:10.1016/s0016-5107(96)70300-0

Cited by 12 publications

(9 citation statements)

References 10 publications

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“…In previous reports intestinal lesions of histoplasmosis were described as masses, ulcers or polyps 1,2 . The present case shows that the lesions can be quite small and plaque‐like.…”

supporting

confidence: 54%

“…Sir : Histoplasmosis of the gastrointestinal tract usually presents in the form of masses causing intestinal obstruction 1,2 . We report here that histoplasmosis of the small intestine can also present in the form of much smaller mucosal lesions, microscopically mimicking Whipple's disease.…”

mentioning

confidence: 89%

“…Most, i.e. 80%, of these infections involve the colon, whereas the small intestine is affected less often 1,2 …”

mentioning

confidence: 99%

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Intestinal histoplasmosis mimicking Whipple's disease

McCullough

Damjanov

2005

Histopathology

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“…In previous reports intestinal lesions of histoplasmosis were described as masses, ulcers or polyps 1,2 . The present case shows that the lesions can be quite small and plaque‐like.…”

supporting

confidence: 54%

mentioning

confidence: 89%

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Intestinal histoplasmosis mimicking Whipple's disease

McCullough

Damjanov

2005

Histopathology

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“…Of the few case reports of duodenal histoplasmosis described in the literature, most have presented with nonspecific symptoms, such as weight loss or abdominal pain, or no symptoms at all [18, 19]. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with melanotic stools and worsening anemia.…”

Section: Discussionmentioning

confidence: 99%

Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient

Spinner

Paulin

Wester

2012

Case Reports in Gastrointestinal Medicine

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Gastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts <100 cells/mm3) who reside in endemic areas (Ohio or Mississippi river valleys) and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole.

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“…In this way we overemphasize the importance of clinical surveillance (signs and symptoms) combined with imaging and clinical laboratory information including histopathology analysis [ 13 , 14 ]. However our case had unusual presentation because gastrointestinal histoplasmosis rarely presents together with fever and lung involvement [ 15 ]. Pathology was definitive ratifying granulomatous infection on liver, later confirmed by culture.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous Hepatitis Secondary toHistoplasmaInfection after Treatment with Infliximab

Barrera

Alvarez

Tapias

et al. 2013

Case Reports in Hepatology

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Classical presentation of Histoplasma infection includes fever and respiratory symptoms. Opportunistic microorganisms must be suspected on immunocompromised patients who develop bizarre symptoms. We present a case of a female patient with rheumatoid arthritis who received treatment with Infliximab during one and a half year; she developed granulomatous hepatitis secondary to Histoplasma infection. The patient was admitted with acute hepatitis and thrombocytopenic coagulopathy. A liver biopsy was performed revealing granulomatous hepatitis, microvesicular steatosis, isolated apoptotic cells, and parenchyma microabscesses. PAS and Gömöri stains revealed areas with mycotic microorganisms morphologically compatible with Histoplasma spp. and confirmed by culture.

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Small intestinal histoplasmosis: successful treatment with itraconazole in an immunocompetent host

Cited by 12 publications

References 10 publications

Intestinal histoplasmosis mimicking Whipple's disease

Intestinal histoplasmosis mimicking Whipple's disease

Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient

Granulomatous Hepatitis Secondary toHistoplasmaInfection after Treatment with Infliximab

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