Colonic Histoplasmosis Presenting as Polyps in an Asymptomatic Patient With Liver Transplant

Area of Science:

• Mycology
• Gastroenterology
• Infectious Diseases

Background:

• Gastrointestinal histoplasmosis is typically a sign of disseminated Histoplasma capsulatum infection.
• Common symptoms include abdominal pain and diarrhea, with isolated asymptomatic cases being rare and difficult to diagnose.

Observation:

• A 57-year-old male liver transplant recipient presented with multiple colonic polyps.
• Biopsies revealed granulomatous colitis with fungal microorganisms identified as Histoplasma capsulatum.

Findings:

• Histoplasma capsulatum infection was confirmed via antigen/antibody tests.
• The patient was asymptomatic with no signs of disseminated disease, including pulmonary involvement.
• Treatment with itraconazole led to a negative urine antigen test within 6 months and resolution of colonic histoplasmosis at 12 months.

Implications:

• This case underscores the possibility of isolated, asymptomatic gastrointestinal histoplasmosis, even in immunocompromised patients like liver transplant recipients.
• Early diagnosis and appropriate antifungal therapy, such as itraconazole, can lead to successful outcomes.
• Highlights the importance of considering fungal infections in the differential diagnosis of colonic polyps and granulomatous colitis.