A Case of Isolated Gastrointestinal Histoplasmosis

An occurrence of intestinal histoplasmosis in a goat flock

Background

The paper describes the first documentary evidence of intestinal histoplasmosis in Indian goats.

Case description

A goat flock in delta region of Tamil Nadu with a report of mortality of eight animals with the history of inappetence, constipation, tenesmus and hematochezia. Three goat carcasses were presented for necropsy.

Findings/treatment and outcome

Postmortem examination showed mesenteric lymphadenomegaly with greyish yellow viscous contents. Ileum contained scattered dark brownish tubular concretions inside the lumen. Colon and caecum had scattered firm serosal and mucosal nodules with caseous exudate. Lumen contained viscous haemorrhagic content. Mucosa of the colon showed numerous tiny ulcers. Urinary bladder serosa showed a focal firm nodule with caseous exudate and irregular firm mass. Microscopically, lung revealed oval inclusions with clear halo in pulmonary macrophages. Caecum and colon showed ulcers with necrotic core. Necrotic border showed multinucleated giant cells and oval bodies with clear halo. Mesenteric lymph node and urinary bladder revealed pyogranulomatous inflammation with aggregation of macrophages filled with numerous tiny inclusions. Periodic acid-Schiff and Grocott's methanamine silver staining techniques and morphological features of the inclusion confirmed it as Histoplasma capsulatum. The case showed a resemblance with human colonic histoplasmosis.

Conclusion

This report documents the first incidence of intestinal histoplasmosis in goats. Interestingly, the intestinal form of histoplasmosis is considered to be common in humans and it showed similarity with human disease in goats based on the gross and microscopic lesions.

Colonic Histoplasmosis Presenting as Polyps in an Asymptomatic Patient With Liver Transplant

Infection of the gastrointestinal tract by Histoplasma capsulatum is generally considered to be a manifestation of disseminated disease. The most common symptoms from gastrointestinal histoplasmosis include abdominal pain and diarrhea. Isolated asymptomatic gastrointestinal histoplasmosis is unusual, and diagnosis can be challenging. We report a 57-year-old man with a history of liver transplant presented with numerous colonic polyps, and the biopsies demonstrated granulomatous colitis with fungal microorganism consistent with H. capsulatum. Antigen/antibody tests for Histoplasma were confirmatory. The patient was asymptomatic with no clinical or radiological evidence of pulmonary involvement. He responded well to itraconazole treatment, and urine antigen tested negative 6 months after the initiation of the treatment. Follow-up colonoscopy performed 12 months after treatment with itraconazole showed no evidence of colonic histoplasmosis.

An HIV-Positive Patient With Disseminated Histoplasmosis Complicated by Histoplasma Ileitis-Induced Small Bowel Obstruction

A 43-year-old male has a medical history of Human immunodeficiency virus (HIV) with no anti-retroviral therapy for six years prior to admission. He presented from an outside hospital with 40 lbs weight loss over one year, worsening abdominal pain, and odynophagia, with CT-confirmed small bowel obstruction (SBO) in the setting of untreated cytomegalovirus (CMV) ileitis. Treatment for both the untreated HIV and CMV ileitis was started during this hospitalization, and his hospital course was complicated by disseminated histoplasmosis in his lungs and GI tract, leading to stricture and a recurrent SBO. This case report will focus on an unusual complication of untreated HIV and a late diagnosis of histoplasmosis: Histoplasma ileitis-induced stricture and recurrent SBO. To date, there are a limited number of reports that describe gastrointestinal histoplasmosis in HIV patients, and SBO remains a rare and serious complication of disseminated histoplasmosis.

Gastrointestinal Histoplasmosis as an Obstructing Ileocecal Mass

Histoplasmosis is a self-limiting and asymptomatic disease in immunocompetent individuals. Patients in an immunocompromised state are susceptible to disseminated disease. We present a case of a 60-year-old male with a history of psoriatic and rheumatoid arthritis treated with a tumor necrosis factor inhibitor (adalimumab), who presented with abdominal pain and was found to have gastrointestinal histoplasmosis as an obstructing ileocecal mass. Although gastrointestinal involvement is common in disseminating disease, symptomatic involvement is rare. This case presentation has implications in rheumatological patients on biologic medications.

A case report of gastrointestinal histoplasmosis in a patient treated with infliximab

Histoplasmosis is an endemic mycosis in some areas of North and South America. This disease is usually asymptomatic, but it can result in severe and disseminated infection involving gastrointestinal tract, especially in immunocompromised individuals. We report a case of a 33-years-old Ecuadorian male treated with infliximab who developed disseminated histoplasmosis with gastrointestinal affection. Due to the non-specific presentation of gastrointestinal histoplasmosis, the diagnosis is often delayed and it causes poor outcomes. It is important to consider this diagnosis in immunocompromised patients with compatible symptoms, like patients on TNF inhibitors.