Gastrointestinal Bleeding and Hemorrhagic Shock in a Patient Diagnosed With Disseminated Histoplasmosis

A 63-year-old patient with HIV/AIDS and hepatitis B virus was found to have disseminated histoplasmosis with gastrointestinal bleeding. The patient was initially treated for sepsis, but the infectious workup was negative. Computed tomography of the abdomen and pelvis showed diffuse mesenteric and retroperitoneal lymphadenopathy, with plan for biopsy. Unfortunately, the patient had a Code Blue after having profuse hematochezia. Esophagogastroduodenoscopy disclosed actively bleeding duodenal ulcer; computed tomography angiography showed gastric and jejunal extravasation. The patient expired, and autopsy revealed histoplasmosis of duodenum and jejunum. Esophagogastroduodenoscopy is particularly helpful for timely diagnosis in immunocompromised patients with gastrointestinal bleed from suspected infections or malignancy.