Histoplasmosis peritonitis in an immunocompetent patient: case report

Area of Science:

• Infectious Diseases
• Mycology
• Gastroenterology

Background:

• Histoplasmosis is a fungal infection endemic in Central/South America and Africa, typically asymptomatic in healthy individuals.
• Extrapulmonary dissemination and gastrointestinal involvement are common in immunocompromised hosts, often mimicking Crohn's disease or malignancy.
• Peritonitis is an uncommon presentation of histoplasmosis, particularly in immunocompetent patients.

Observation:

• A 36-year-old healthy man from Cameroon presented with peritonitis unresponsive to antibiotics.
• CT-scan revealed bowel obstruction and peritonitis, leading to exploratory laparotomy.
• Histoplasmosis was confirmed via histology and PCR analysis of biopsy samples.

Findings:

• The patient was immunocompetent, with no prior medical or surgical history.
• The primary manifestation was peritonitis due to disseminated histoplasmosis involving the peritoneum.
• This represents the first reported case of peritonitis as the main outcome of disseminated histoplasmosis in an immunocompetent patient.

Implications:

• This case expands the clinical spectrum of histoplasmosis, demonstrating its potential to cause severe intra-abdominal complications in immunocompetent individuals.
• Clinicians should consider disseminated histoplasmosis in the differential diagnosis of peritonitis, especially in patients with relevant geographical exposure, regardless of immune status.
• Further research may be warranted to understand the mechanisms underlying peritoneal involvement in immunocompetent hosts with histoplasmosis.