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Disseminated histoplasma and CMV infection presenting as subacute intestinal obstruction in an immunocompromised

Lokesh Shahani1

  • 1Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, United States. lokesh83@hotmail.com

BMJ Case Reports
|May 19, 2012
PubMed

Insights

Progressive disseminated histoplasmosis and cytomegalovirus (CMV) are opportunistic infections in immunocompromised patients. This case highlights concurrent Histoplasma and CMV infections causing intestinal obstruction in an immunocompromised patient.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Immunology

Background:

  • Progressive disseminated histoplasmosis and cytomegalovirus (CMV) are significant opportunistic infections in immunocompromised individuals.
  • Patients on immunosuppressive therapy, such as prednisone and methotrexate, are at increased risk for disseminated infections.

Observation:

  • An older male on chronic immunosuppressive therapy presented with symptoms and radiological evidence of subacute intestinal obstruction.
  • Colonoscopy revealed a proximal ascending colon stricture with ulceration and granulomatous inflammation.
  • Biopsy confirmed Histoplasma capsulatum and cytomegalovirus (CMV) coinfection within the colonic stricture.

Findings:

  • Histopathological examination identified fungal elements consistent with Histoplasma capsulatum.
  • Immunohistochemistry confirmed the presence of cytomegalovirus (CMV) in the affected tissue.
  • The patient demonstrated a positive response to antimicrobial therapy, with no progression of intestinal obstruction.

Implications:

  • This case underscores the importance of considering infectious etiologies, including concurrent fungal and viral infections, in immunocompromised patients with obstructive gastrointestinal symptoms.
  • Early diagnosis and appropriate antimicrobial treatment are crucial for managing disseminated infections and preventing complications like intestinal obstruction.
  • Highlights the diagnostic challenges and clinical significance of opportunistic infections in immunocompromised hosts, particularly co-infections.

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