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[A case of disseminated histoplasmosis due to Histoplasma capsulatum (author's transl)]
Abstract:
A case is reported of American histoplasmosis due to Histoplasma capsulatum presenting as a hepatic granulomatosis. The patient was a young adult from Haiti and investigations revealed the presence of an ulcerous enterocolitic suggesting tuberculosis or Crohn's disease. The condition became worse after antituberculous therapy and corticoids, and operation was necessary. Extemporaneous histological examination, of the colonic ulcerations showed Histoplasma capsultaum yeasts. The patient, who had a cellular immunity deficiency, died during antifungal treatment with amphotericin B of the disseminated histoplasmosis is rare: 1 case in 5000 American histoplasmosis cases. Digestive tract lesions, usually detected during operation or autopsy, are found in about 20% of cases. In the present observations the diagnosis of American histoplasmosis was based on the country of origin of the patient, but this was not confirmed: the immunological reactions were and remained negative and no yeasts were demonstrated after staining of pre-operative biopsy specimens (colon and liver particularly). Also, serial sections conducted after the diagnosis had been established demonstrated the presence of Histoplasma capsulatum in the colon sample removed during colonoscopy.
Insights
This case report details a rare instance of disseminated American histoplasmosis caused by Histoplasma capsulatum, presenting as hepatic granulomatosis and severe gastrointestinal issues. Despite treatment, the patient with immune deficiency succumbed to the disseminated fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Pathology
Background:
- American histoplasmosis is a fungal infection caused by Histoplasma capsulatum.
- Disseminated forms are rare, particularly with gastrointestinal involvement.
Observation:
- A young adult from Haiti presented with symptoms mimicking tuberculosis or Crohn's disease.
- Initial treatments with antituberculous therapy and corticoids worsened the condition.
- Histoplasma capsulatum yeasts were identified in colonic ulcerations during surgery.
Findings:
- The patient had a cellular immunity deficiency, contributing to the disseminated infection.
- Diagnosis was challenging due to negative immunological tests and initial negative biopsies.
- Histoplasma capsulatum was confirmed in colon samples post-diagnosis via serial sectioning.
Implications:
- Highlights the importance of considering Histoplasma capsulatum in endemic areas, even with atypical presentations.
- Underscores the diagnostic challenges in immunocompromised patients with gastrointestinal symptoms.
- Emphasizes the potential severity and poor prognosis of disseminated histoplasmosis despite treatment.