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Histoplasmosis capsulatum as a cause of lower gastrointestinal bleeding in common variable immunodeficiency
1The University of Chicago Hospitals, Illinois, USA.
Abstract:
Infection with Histoplasma capsulatum is the most common systemic fungal infection in the United States, but symptomatic gastrointestinal disease is rare. Gastrointestinal involvement is seen in patients with an established immunosuppressed state that predates any infection. We report a patient presenting with gastrointestinal bleeding ultimately diagnosed with disseminated histoplasmosis. Work-up led to the diagnosis of common variable immunodeficiency, a diagnosis not previously described as associated with gastrointestinal histoplasmosis. Resolution of the colonic ulcer was documented after appropriate antifungal therapy, underscoring the importance of including this infectious process in the differential of a patient without other risk factors for colonic ulceration.
Insights
Histoplasma capsulatum causes common fungal infections, but rare gastrointestinal disease. This case highlights common variable immunodeficiency as a risk factor for disseminated histoplasmosis presenting as gastrointestinal bleeding.
Area of Science:
- Mycology
- Immunology
- Gastroenterology
Background:
- Histoplasma capsulatum is a common systemic fungal infection in the US.
- Gastrointestinal histoplasmosis typically occurs in severely immunocompromised individuals.
- Symptomatic gastrointestinal disease is a rare manifestation of histoplasmosis.
Observation:
- A patient presented with unexplained gastrointestinal bleeding.
- The patient was diagnosed with disseminated histoplasmosis.
- Further investigation revealed common variable immunodeficiency (CVID).
Findings:
- This is the first reported case of gastrointestinal histoplasmosis associated with CVID.
- The patient's colonic ulcer resolved with antifungal treatment.
- Disseminated histoplasmosis can occur in patients with CVID.
Implications:
- Common variable immunodeficiency should be considered in the differential diagnosis of patients with gastrointestinal histoplasmosis.
- Early diagnosis and treatment of histoplasmosis are crucial for patient outcomes.
- This case expands the understanding of risk factors for gastrointestinal fungal infections.