Gastrointestinal histoplasmosis presenting as colonic pseudotumour

Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis

Patient: Male, 66

Final Diagnosis: Perianal histoplasmosis

Symptoms: Perianal pain

Medication: —

Clinical Procedure: Surgical biopsy of the lesion

Specialty: Pathology

Gastrointestinal Histoplasmosis: A Case Series

Histoplasmosis is an invasive mycosis caused by inhalation of the spores of dimorphic fungi Histoplasma capsulatum. The disease manifests in the lung as acute or chronic pulmonary histoplasmosis and in severe cases gets disseminated in multiple organs like skin, adrenal gland, central nervous system, lymph node, liver, spleen, bone marrow, and gastrointestinal tract. It occurs most commonly in immunodeficient patients like HIV-positive patients and transplant recipients, while immunocompetent hosts are affected rarely. In cases of gastrointestinal histoplasmosis, the samples are collected for culture and biopsy should be sent for histopathological examination for definitive diagnosis. We conducted a retrospective study of colonic biopsies performed in the department of gastroenterology in a tertiary care hospital of north India from January 2014 to December 2015. Five cases of colonic histoplasmosis were diagnosed on histopathology out of which 4 patients were from north India while 1 patient was from Myanmar. The patients presented with various complaints, including loose stools, diarrhea, altered bowel habits, and gastrointestinal bleeding. The prognosis is very good after early and aggressive treatment while the disease is fatal if it remains untreated. In our study, 2 patients died within few days of diagnosis due to delay in the diagnosis, dissemination, and associated complications. Other patients were started on amphotericin B deoxycholate and are under follow-up. An early diagnosis of gastrointestinal histoplasmosis is important as appropriate treatment leads to long-term survival while untreated cases are almost fatal.

Isolated Ileal Stricture Secondary to Antigen-Negative GI Histoplasmosis in a Patient on Immunosuppressive Therapy

We present a case of antigen-negative disseminated histoplasmosis manifesting as an isolated ileal stricture in a patient on chronic infliximab and methotrexate. Diagnosis can be challenging due to imperfect tests, and this condition should remain in the differential, even with negative testing. Mortality of untreated disseminated histoplasmosis can be as high as 80%.

A Rare Case of Juvenile Systemic Lupus Erythematosus with Disseminated Histoplasmosis

Histoplasmosis is a systemic fungal infection caused by dimorphic fungus, Histoplasma capsulatum. Immunocompetent individuals usually have self-limiting or localized disease whereas immunocompromised individuals develop disseminated disease. The occurrence of progressive disseminated histoplasmosis in juvenile systemic lupus erythematosus is extremely rare with only one reported case in literature showing such association. Therefore, we report a case of severe opportunistic fungal infection caused by Histoplasma in a 13-year-old girl who was diagnosed with juvenile lupus erythematosus, subsequently developed septic shock and died of the disease despite of aggressive antifungal therapy.

Human immunodeficiency virus-associated adenocarcinoma of the colon: clinicopathologic findings and outcome

BACKGROUND

Patients infected with Human immunodeficiency virus (HIV) living longer with antiretroviral therapy (ART) are more likely to develop non-AIDS-defining cancers such as adenocarcinoma of the colon. There have been limited case reports regarding HIV-associated colon adenocarcinoma. The aim of this study was to characterize the clinicopathologic findings and outcome in a series of HIV-infected patients diagnosed and treated for colon adenocarcinoma.

PATIENTS AND METHODS

A retrospective study involving HIV-related colon adenocarcinoma was performed. Cases were accrued from the personal archives and published case reports. Data regarding demographics, HIV acquisition, ART use, immunosuppression, cancer location, pathology, and outcome were extracted and analyzed.

RESULTS

A total of 17 patients were identified, including 7 personal cases. Patients were of average age 43 years (range, 25-67 years) and predominantly male (male:female ratio, 14:3). Most carcinomas (57%) involved the right colon, were largely TNM stage 4 cancers (47%), and, when present, metastases were mainly to the liver. Many (47%) individuals died within 1-26 months after their cancer diagnosis. Immunosuppression (AIDS diagnosis and/or CD4+ < 500 cells/mm3) did not appear to correlate with tumor grade, stage, or an adverse outcome.

CONCLUSION

These data show that HIV-infected patients with adenocarcinoma of the colon tend to be young men with a high incidence of right-sided involvement. Additional research is needed to determine if screening HIV-infected individuals for colon cancer should include younger patients and involve the entire colon.