Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient
Gastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from d...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2012/515872 |
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| author | Michael A. Spinner Heather N. Paulin C. William Wester |
| author_facet | Michael A. Spinner Heather N. Paulin C. William Wester |
| author_sort | Michael A. Spinner |
| collection | DOAJ |
| description | Gastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts cells/mm3) who reside in endemic areas (Ohio or Mississippi river valleys) and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole. |
| format | Article |
| id | doaj-art-8cade2521242409283625f9ae6048e52 |
| institution | Kabale University |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-8cade2521242409283625f9ae6048e522025-02-03T06:00:45ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362012-01-01201210.1155/2012/515872515872Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS PatientMichael A. Spinner0Heather N. Paulin1C. William Wester2Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN 37232-2582, USADivision of Infectious Diseases, Vanderbilt University School of Medicine, A2200 MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USADivision of Infectious Diseases, Vanderbilt University School of Medicine, A2200 MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USAGastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts cells/mm3) who reside in endemic areas (Ohio or Mississippi river valleys) and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole.http://dx.doi.org/10.1155/2012/515872 |
| spellingShingle | Michael A. Spinner Heather N. Paulin C. William Wester Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient Case Reports in Gastrointestinal Medicine |
| title | Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient |
| title_full | Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient |
| title_fullStr | Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient |
| title_full_unstemmed | Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient |
| title_short | Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient |
| title_sort | duodenal histoplasmosis presenting with upper gastrointestinal bleeding in an aids patient |
| url | http://dx.doi.org/10.1155/2012/515872 |
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