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Colonic Histoplasmosis Presenting as Polyps in an Asymptomatic Patient With Liver Transplant
Min Cui1, Richard C K Wong2, Pierre M Gholam2
1Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Abstract:
Infection of the gastrointestinal tract by Histoplasma capsulatum is generally considered to be a manifestation of disseminated disease. The most common symptoms from gastrointestinal histoplasmosis include abdominal pain and diarrhea. Isolated asymptomatic gastrointestinal histoplasmosis is unusual, and diagnosis can be challenging. We report a 57-year-old man with a history of liver transplant presented with numerous colonic polyps, and the biopsies demonstrated granulomatous colitis with fungal microorganism consistent with H. capsulatum. Antigen/antibody tests for Histoplasma were confirmatory. The patient was asymptomatic with no clinical or radiological evidence of pulmonary involvement. He responded well to itraconazole treatment, and urine antigen tested negative 6 months after the initiation of the treatment. Follow-up colonoscopy performed 12 months after treatment with itraconazole showed no evidence of colonic histoplasmosis.
Insights
Isolated gastrointestinal histoplasmosis, a rare fungal infection, can present asymptomatically. This case highlights a liver transplant patient with colonic polyps caused by Histoplasma capsulatum, successfully treated with itraconazole.
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.
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