ABSTRACT
@#Introduction: Histoplasmosis can present in a myriad of clinical manifestations, which often makes its diagnosis difficult and occasionally, deceptive. Case Report: We describe a case of a 33 years old gentleman who was clinically diagnosed as acute appendicitis at initial presentation in view of a one-week history of fever, right lower quadrant abdominal pain- and guarding at right iliac fossa. He had thrombocytopenia and lymphopenia on presentation. Mesenteric lymphadenitis and small bowel lesion were found intraoperatively, which was respectively biopsied and resected. Histopathological result confirms disseminated histoplasmosis. Retroviral screen was positive. He was treated with amphotericin B for one week, subsequently switched to oral itraconazole, followed by initiation of highly active antiretroviral therapy (HAART). Discussion: This case illustrates the various nature of histoplasmosis presentation. A high index of suspicion is needed to clinch the diagnosis and subsequently institute prompt treatment as disseminated disease can be fatal if left untreated in an immunosuppressed host.
Subject(s)
HistoplasmosisABSTRACT
JUSTIFICATIVA E OBJETIVOS: A histoplasmose é uma doença fúngica causada pelo Histoplasma capsulatum. É rara em imunocompetentes;no entanto, em pacientes imunossuprimidos, a infecção ocorre de forma disseminada e grave, podendo acometer vários órgãos, incluindo o trato gastrintestinal. O objetivo deste estudo foi relatar o caso de uma apresentação incomum de infecção pelo H. capsulatum, alertando os clínicos quanto à inclusão da histoplasmose no diagnóstico diferencial de úlceras gastrintestinais, principalmente no paciente imunocomprometido. RELATO DO CASO: Paciente do sexo masculino, 45 anos,portador de síndrome da imunodeficiência adquirida (SIDA),com perda de peso, febre, sudorese noturna, adenomegalias cervicais e sangramento gastrintestinal. A radiografia de tórax mostrou infiltrado intersticial bilateral difuso, e a tomografia computadorizada (TC) de abdômen mostrou hepatomegalia e adenomegalias intra-abdominais. Na endoscopia digestiva alta foram encontradas úlceras no estômago e duodeno. O exame anatomopatológico das lesões foi compatível com histoplasmose do trato gastrintestinal. CONCLUSÃO: É de extrema importância o diagnóstico diferencial de úlceras gastrintestinais, principalmente em pacientes imunossuprimidos, uma vez que diversas doenças que assim se manifestam se não tratadas adequadamente, têm evolução fatal.
BACKGROUND AND OBJECTIVES: Histoplasmosis is afungal disease caused by Histoplasma capsulatum. It rarely occurs in immunocompetent individuals; however, in immunocompromised patients, the infection is usually severe and disseminated. Many organs can be affected, including the gastrointestinal tract.The objective of this study is to report an uncommon presentation of histoplasmosis, showing that the differential diagnosis of gastrointestinal ulcers is of great importance, particularly in the immunocompromised patient. CASE REPORT: Male patient, 45-year-old, immunodeficiency virus human-positive, was admitted to the hospital presenting with weight loss, night sweats, fever, cervical adenomegalies and gastrointestinal bleeding. Chest radiography showed diffuse interstitial pulmonary infiltrates bilaterally; computerized tomography of the abdomen showed hepatomegaly and intraabdominal adenomegalies. Upper gastrointestinal endoscopy revealed gastric and duodenal ulcers. The pathologic examination of the ulcerswas consistent with gastrointestinal histoplasmosis. CONCLUSION: Reassures the need for the differential diagnosis of gastrointestinal ulcers, particularly in immunosuppressed patients, since many diseases that present this way, have fatal outcomeif not treated properly.
Subject(s)
Humans , Male , Middle Aged , Histoplasmosis/diagnosis , Mycoses , Acquired Immunodeficiency Syndrome/complications , Peptic Ulcer/diagnosisABSTRACT
Se reporta caso de paciente mujer de 48 años, sin antecedentes importantes (niega transfusión de sangre), con cuatro meses con diarrea y pérdida ponderal de 8 kg. Presenta episodio de hematoquezia y anemia aguda que requirió transfusión. Se realizó colonoscopía intrahemorrágica detectando tres lesiones ulceradas: una a 10 cm del ano, otra en colon transverso distal, otra úlcera de similares características en el transverso proximal. Las biopsias mostraron tejido de granulación de úlcera, abundantes macrófagos con estructuras intracitoplasmáticas consistentes con histoplasmosis. Los exámenes no demostraron tuberculosis, ni parasitosis intestinal. Las pruebas de VIH (ELISA y Western Blot) fueron positivas. El recuento de linfocitos CD4 (78 células) y la histoplasmosis extrapulmonar fueron los criterios que definieron el estadio SIDA. La histoplasmosis extrapulmonar define el estadio IV en pacientes inmunosuprimidos por el VIH. La hemorragia digestiva baja por úlceras colónicas secundarias a Histoplasma es una forma de presentación infrecuente como manifestación diagnóstica de SIDA.
We report the case of 48 year old female patient without a history of significance importance (refuses blood transfusion). She complaint of diarrhea of four months of duration and weight loss of 8 kg. She added episodes of hematochezia and severe anemia requiring transfusion. An Intrahemorrhagic colonoscopy was performed detecting three ulcerated lesions. First at 10 cm from the anus, one in transverse colon distal, another similar ulcer in the proximal transverse The biopsies showed ulcer granulation tissue, abundant macrophages within tracytoplasmic structures consistent with histoplasmosis. Tests showed no tuberculosis or intestinal parasitosis. HIV testing (ELISA and Western Blot) were positive. The CD4 (78 cells) and extrapulmonary histoplasmosis were the criteria defined stage AIDS. The extrapulmonary histoplasmosis defines stage IV in immunosuppressed patients with HIV. Lower gastrointestinal bleeding colonic ulcer secondary to Histoplasma is a rare form presentation as a diagnostic manifestation of AIDS.