P069 The Unrelenting Ulcer

Area of Science:

• Gastroenterology
• Infectious Diseases
• Immunology

Background:

• Inflammatory Bowel Disease (IBD) prevalence is rising globally.
• Immunosuppressive therapies, particularly anti-tumor necrosis factor (anti-TNF) agents, are widely used for IBD management.
• Patients on immunosuppression are at increased risk for opportunistic infections.

Purpose of the Study:

• To highlight the risks, presentation, and management of disseminated histoplasmosis (DH) in IBD patients on immunosuppression.
• To emphasize the importance of considering DH in IBD patients with atypical gastrointestinal symptoms.
• To discuss the diagnostic challenges and treatment strategies for DH in this population.

Main Methods:

• Case presentation of a patient with Ulcerative Colitis (UC) on Infliximab presenting with a non-healing duodenal ulcer.
• Review of patient's history, clinical presentation, laboratory findings, and imaging studies (EGD, CT, EUS).
• Diagnostic workup including biopsies, immunodiffusion testing, and infectious disease consultation.

Main Results:

• A 49-year-old male with UC on Infliximab developed a large, non-healing duodenal ulcer mimicking IBD.
• Disseminated histoplasmosis was diagnosed after ruling out other etiologies and identifying bird dropping exposure.
• Treatment with Itraconazole was initiated, Infliximab was held, and mesalamines were restarted, leading to symptomatic improvement.

Conclusions:

• Disseminated histoplasmosis can present atypically in IBD patients on anti-TNF therapy, mimicking disease flares or complications.
• Awareness of potential exposures and atypical presentations is vital for early diagnosis and intervention.
• Prompt cessation of immunosuppression and initiation of antifungal therapy are critical for managing DH in IBD patients.