Gastric Involvement With Disseminated Histoplasmosis in an Immunocompetent Patient From a Nonendemic Region

Gastric involvement with Histoplasma capsulatum infection is rare but can mimic peptic ulcers or cancer, delaying diagnosis. A 71-year-old man presented with oral ulcer, abdominal pain, and weight loss. The patient had history of tonsillar histoplasmosis treated 8 years before the current presentation with confirmed resolution. The patient had no history of malignancy, autoimmune diseases, or recent travel. Initial laboratory evaluation revealed normocytic anemia. Imaging did not show acute abnormalities that would account for his symptoms. Esophagogastroduodenoscopy revealed multiple gastric ulcers. Biopsies showed chronic gastritis with ulceration and fungal yeasts consistent with H. capsulatum. Similarly, the oral ulcer showed non-necrotizing granulomas with fungal forms. Itraconazole was initiated and follow-up esophagogastroduodenoscopy showed healing ulcers.