Gastrointestinal histoplasmosis simulating crohn’s disease in an immunosuppressed patient: a case report

Authors

  • Caio Guimarães Araújo
  • Jarom de Paula Maia
  • Claudia Biasutti
  • Esteban Sadovsky
  • Maria da Penha Zago-Gomes

DOI:

https://doi.org/10.47456/rbps.v26isupl_1.44397

Keywords:

Disseminated histoplasmosis, Histoplasma capsulatum, Opportunistic infections, HIV

Abstract

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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References

Sharma R, Lipi L, Gajendra S, Mohapatra I, Goel RK, Duggal R, Mishra SR, Gautam D. Gastrointestinal Histoplasmosis: A Case Series. Int J Surg Pathol. 2017 Oct;25(7):592-598. doi: 10.1177/1066896917709945.

Ekeng BE, Itam-Eyo AE, Osaigbovo II, Warris A, Oladele RO, Bongomin F, Denning DW. Gastrointestinal Histoplasmo¬sis: A Descriptive Review, 2001-2021. Life (Basel). 2023 Mar 3;13(3):689. doi: 10.3390/life13030689.

Kahi CJ, Wheat LJ, Allen SD, Sarosi GA. Gastrointestinal his¬toplasmosis. Am J Gastroenterol. 2005 Jan;100(1):220-31. doi: 10.1111/j.1572-0241.2005.40823.x.

Suh KN, Anekthananon T, Mariuz PR. Gastrointestinal histo¬plasmosis in patients with AIDS: case report and review. Clin Infect Dis. 2001 Feb 1;32(3):483-91. doi: 10.1086/318485.

Assi M, McKinsey DS, Driks MR, O’Connor MC, Bonacini M, Graham B, Manian F. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review. Diagn Microbiol Infect Dis. 2006 Jul;55(3):195- 201. doi: 10.1016/j.diagmicrobio.2006.01.015. Epub 2006 Mar 20.

Wheat LJ, Connolly-Stringfield PA, Baker RL, Curfman MF, Eads ME, Israel KS, Norris SA, Webb DH, Zeckel ML. Disseminated histoplasmosis in the acquired immune deficiency syn¬drome: clinical findings, diagnosis and treatment, and review of the literature. Medicine (Baltimore). 1990 Nov;69(6):361-74. doi: 10.1097/00005792-199011000-00004.

McCluskey SM, Pepperrell T, Hill A, Venter WDF, Gupta RK, Siedner MJ. Adherence, resistance, and viral suppression on dolutegravir in sub-Saharan Africa: implications for the TLD era. AIDS. 2021 Dec 15;35(Suppl 2):S127-S135. doi: 10.1097/ QAD.0000000000003082.

Suárez-García I, Alejos B, Hernando V, Viñuela L, Vera García M, Rial-Crestelo D, Pérez Elías MJ, Albendín Iglesias H, Peraire J, Tiraboschi J, Díaz A, Moreno S, Jarrín I; Cohort of the Spanish HIV/AIDS Research Network (CoRIS). Effectiveness and toler¬ability of dolutegravir/lamivudine for the treatment of HIV-1 infection in clinical practice. J Antimicrob Chemother. 2023 Jun 1;78(6):1423-1432. doi: 10.1093/jac/dkad102.

Published

2024-04-30

How to Cite

1.
Guimarães Araújo C, de Paula Maia J, Biasutti C, Sadovsky E, Zago-Gomes M da P. Gastrointestinal histoplasmosis simulating crohn’s disease in an immunosuppressed patient: a case report. RBPS [Internet]. 2024 Apr. 30 [cited 2024 Nov. 5];26(supl_1):68-75. Available from: https://periodicos.ufes.br/rbps/article/view/44397

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