Crohn's disease or histoplasmosis? A case of severe disseminated histoplasmosis mimicking Crohn's disease and literature review

Ahmed, Ahmed; Homsi, Nora; Kapila, Rajendra

doi:10.1016/j.mmcr.2020.08.003

Cited by 9 publications

(15 citation statements)

References 20 publications

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“…Analysis of the 123 well-documented cases showed the clinical presentation of GIH was often non-specific and mimicked several other gastrointestinal conditions and pathologies, including abdominal tuberculosis (n = 3, 2.4%) [ 85 , 96 , 102 ], GIH and TB coinfection was reported in four [3.3%] cases [ 78 , 87 , 96 , 98 ], inflammatory bowel disease (n = 9, 7.3%) [ 21 , 33 , 40 , 52 , 69 , 75 , 89 , 105 , 107 ], intestinal obstruction (n = 15, 12.2%) [ 15 , 21 , 39 , 50 , 57 , 64 , 71 , 77 , 81 , 89 , 95 , 102 , 103 , 104 , 117 ], abdominal malignancy (n = 9, 7.3%) [ 14 , 16 , 31 , 80 , 83 , 101 , 102 , 108 , 112 ], GI bleeding (n = 29, 23.6%) [ 17 , 18 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 37 , 41 , 44 , 53 , 56 ,…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Ekeng

Itam-Eyo

Osaigbovo

et al. 2023

Life

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Gastrointestinal histoplasmosis (GIH) is infrequently described in people without underlying HIV infection. We aimed to compare the clinical presentation of GIH in people with and without HIV infection. We conducted a literature search of published cases of GIH from 2001–2021 and found 212 cases. Of these, 142 (67.0%) were male, and 124 (58.5%) had HIV infection. Most cases were from North America (n = 88, 41.5%) and South America (n = 79, 37.3%). Of the 212 cases, 123 (58.0%) were included in both clinical and pathological analyses. The remainder were excluded as details about clinical and pathological findings were not available. Of the 123 cases, 41 had HIV infection while 82 were without HIV infection. The diagnosis was predominantly by histopathology (n = 109, 88.6%). A significant proportion of people with HIV infection had abdominal pain as the most predominant symptom of GIH compared to those without HIV infection (65.9% versus 41.9%, p < 0.05). The colon was the most affected site with a slightly higher proportion in those with HIV infection compared with cases without HIV infection (46.3% versus 42.7%). The commonest pathologic findings were caecal and ileal ulcers. Caecal ulcers were significantly more frequent in cases with HIV infection compared to those without HIV (32.1% versus 7.1%, p < 0.05). Despite being more common in people with HIV infection, GIH also affects people without HIV infection with similar clinical presentations.

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Section: Resultsmentioning

confidence: 99%

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Ekeng

Itam-Eyo

Osaigbovo

et al. 2023

Life

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“…Other infectious diseases including endemic systemic mycoses such as histoplasmosis [ 11 ] may present initially with gastrointestinal symptoms and should be considered in the differential diagnosis of these patients before initiating immunosuppressive therapy. Early clinical suspicion, laboratory diagnosis and specific treatment can help to prevent poor outcomes.…”

Section: Case Discussionmentioning

confidence: 99%

Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease

Falcão¹,

Medeiros

Freitas

et al. 2023

PLoS Negl Trop Dis

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Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-year-old male, resident of Rio de Janeiro, presenting chronic diarrhea and abdominal pain in the past 3 years, previously diagnosed as Chron´s disease. When immunosuppressive therapy was prescribed, the patient evolved with worsening of the previous symptoms in addition to odynophagia, 20 kg-weight loss, disseminated skin lesions, diffuse lymphadenopathy and adrenal insufficiency. Histopathological and mycological examination of a skin lesion were compatible with PCM. Itraconazole was prescribed in high doses (400 mg/day). After seven months of treatment, the patient presented with acute abdominal pain which led to an emergent appendectomy, revealing the presence of the fungus. After 24 months, the patient reached clinical cure and recovered from adrenal insufficiency. We emphasize the importance of PCM as a differential diagnosis in patients with chronic diarrhea. The risk of fungal infections should be considered prior to initiating immunosupressive therapies, particularly in endemic areas.

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“…Diagnostic delays associated with histoplasmosis are commonly reported in the literature, and the disease can present with many different symptoms that are common to a wide range of other diseases [ 17 , 18 , 23 ]. For example, histoplasmosis can mimic the presentation of other respiratory infections [ 20 ], malignancies [ 22 ], and autoimmune diseases [ 9 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Because of the varied non-specific symptoms, the diagnosis of histoplasmosis is difficult. It can be confused with other infectious diseases (e.g., community-acquired pneumonia [ 20 ] and tuberculosis [ 21 ]), as well as non-infectious diseases (e.g., malignancies [ 22 ] and autoimmune disease [ 23 , 24 ]).…”

Section: Introductionmentioning

confidence: 99%

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

Arakkal

Koeneman

Cavanaugh

et al. 2022

JoF

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Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001–2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed.

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Crohn's disease or histoplasmosis? A case of severe disseminated histoplasmosis mimicking Crohn's disease and literature review

Cited by 9 publications

References 20 publications

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

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