Disseminated Histoplasmosis Causing Temporally and Spatially Discrete Gastrointestinal Perforations in an...

Area of Science:

• Mycology
• Infectious Diseases
• Gastroenterology

Background:

• Histoplasma capsulatum is a dimorphic fungus prevalent in the Ohio and Mississippi River valleys.
• Infection typically causes asymptomatic or mild illness in immunocompetent individuals.
• Pulmonary manifestations are the most common presentation of symptomatic histoplasmosis.

Observation:

• A young, HIV-negative male presented with recurrent ileal and jejunal perforations.
• The patient underwent four exploratory laparotomies over four months.
• Biopsy confirmed gastrointestinal histoplasmosis as the cause of the perforations, including a gastric perforation.

Findings:

• Gastrointestinal histoplasmosis can manifest as severe, life-threatening intestinal perforations.
• This case demonstrates a rare occurrence in an immunocompetent host.
• Maximal medical therapy was insufficient to prevent surgical complications.

Implications:

• Highlights the potential for severe gastrointestinal complications from Histoplasma capsulatum infection, even in immunocompetent patients.
• Suggests the need for increased awareness of non-pulmonary histoplasmosis presentations.
• Underscores the challenges in managing severe gastrointestinal histoplasmosis and the potential need for aggressive surgical intervention.