Gastrointestinal histoplasmosis simulating crohn’s disease in an immunosuppressed patient: a case report
DOI:
https://doi.org/10.47456/rbps.v26isupl_1.44397Keywords:
Disseminated histoplasmosis, Histoplasma capsulatum, Opportunistic infections, HIVAbstract
Introduction: Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Its most common presentation occurs in immunocompromised patients, where progression to the disseminated form of the infection is more frequent. Gastrointestinal histoplasmosis is one of the most frequent presentations of the disseminated form, but it is rarely diagnosed. Case presentation: Female patient, 37 years old, diagnosed with HIV 14 years ago, undergoing irregular treatment. Admitted due to chronic diarrhea and weight loss. Colonoscopy showed ileitis and extensive ulcerated colitis, and serial biopsies were performed from the ileum to the rectum. Upper digestive endoscopy revealed an active ulcer in the cardia, pangastritis and erosive bulboduodenitis, and biopsies where performed in these regions. The histopathological analysis of both exams showed frequent yeast-like structures suggestive of Histoplasma capsulatum. Treatment with amphotericin B lipid complex was started and, after 14 days, the patient was discharged from hospital using oral itraconazole with improvement in symptoms. Conclusion: Grastointestinal histoplasmosis is a common infection in immunosuppressed individuals, but is rarely diagnosed. Diagnostic methods are varied, but preference should be given to those that present good sensitivity and rapid diagnosis. It is necessary to be aware of differential diagnoses, as clinical, radiological and endoscopic findings can often mimic other clinical conditions. Misdiagnosis can lead to catastrophic results, as disseminated histoplasmosis is fatal if left without adequate treatment. The choice of treatment is based on the severity of the disease, requiring maintenance treatment until there is adequate restoration of the patient’s immune system.
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