Gastrointestinal Histoplasmosis as an Obstructing Ileocecal Mass

A Rare Case of Disseminated Histoplasmosis Involving the Colon and Brain

Histoplamsa capsulatum, the causative organism for histoplasmosis, is a dimorphic fungus seen abundantly along the river valleys of Ohio and Mississippi in the United States of America as well as in other parts of the world. The infection is primarily acquired by inhaling the fungal spores which are often found in bird and bat droppings. Histoplasmosis can have a wide range of presentations ranging from no symptoms to mild flu-like or life-threatening consequences if severe. Chronic histoplasmosis can be akin to tuberculosis with a history of weight loss or hemoptysis. In patients with weak immune systems, histoplasmosis can become disseminated, affecting different parts of the body, which can be fatal if left untreated. We present a 40-year-old male with a past medical history of alcoholic cirrhosis and portal hypertension presenting with lower GI bleed found to have rectal and colonic ulcers as well as multiple brain lesions from disseminated histoplasmosis.

Histoplasmosis peritonitis in an immunocompetent patient: case report

Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn's disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.