A case of gastrointestinal histoplasmosis with esophageal involvement

Mathew Finniss1, Paul Lewis2, James Myers1,3

  • 1Department of Internal Medicine, East Tennessee State University Quillen College of Medicine, VA Building 1, Box 70622, Johnson City, TN, 37614, USA.

Insights

Disseminated histoplasmosis, a fungal infection, can affect the esophagus, particularly in immunocompromised individuals. This case highlights esophageal histoplasmosis without mediastinal lymph node involvement, offering insights into rare presentations.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, endemic to specific regions.
  • Disseminated disease occurs in individuals with compromised cellular immunity, including those with HIV/AIDS.
  • Commonly affected organs include lungs, liver, spleen, bone marrow, and the gastrointestinal tract.

Observation:

  • Esophageal involvement in disseminated histoplasmosis is infrequent.
  • Typically, esophageal compromise results from external compression by enlarged lymph nodes.
  • This report details a rare instance of esophageal histoplasmosis without mediastinal lymphadenopathy.

Findings:

  • A case of disseminated histoplasmosis presenting with esophageal involvement is described.
  • The patient had acquired immunodeficiency syndrome (AIDS), a condition of impaired cellular immunity.
  • Crucially, there was no evidence of mediastinal or hilar lymph node enlargement.

Implications:

  • This case expands the understanding of rare esophageal manifestations of disseminated histoplasmosis.
  • It underscores the importance of considering unusual presentations in immunocompromised patients.
  • Highlights the need for thorough investigation even in the absence of typical radiological findings like lymphadenopathy.

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