Cytology of Gastrointestinal Histoplasmosis

Mullick, Seema S.; Mody, Dina R.; Schwartz, Mary R.

doi:10.1159/000334015

Cited by 17 publications

(3 citation statements)

References 11 publications

(11 reference statements)

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“…Proctoscopy revealed polyps in the anal canal and rectum that were biopsied and were positive for histoplasmosis. Another case, reported by Mullick et al, involved a 69-year-old man with an apparently non-compromised immune system who presented with lower gastrointestinal tract bleeding [8]. Colonoscopy revealed a fungating anal mass that was biopsied because of suspicion for squamous cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…There are several case reports in the literature of patients who presented with gastrointestinal symptoms, but who lacked systemic, pulmonary, or cutaneous symptoms [5]. Histoplasmosis can cause malabsorption [6], lower gastrointestinal tract bleed [7], colonic pseudotumor [8,9], or non-specific gastrointestinal symptoms such as diarrhea, bloating, constipation, abdominal pain, and weight loss [10]. The differential diagnosis for these patients is broad and includes inflammatory diseases such as tuberculosis, inflammatory bowel disease, and opportunistic infections, as well as malignancy.…”

Section: Introductionmentioning

confidence: 99%

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Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis

et al. 2019

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Patient: Male, 66Final Diagnosis: Perianal histoplasmosisSymptoms: Perianal painMedication: —Clinical Procedure: Surgical biopsy of the lesionSpecialty: PathologyObjective:Unusual clinical courseBackground:Disseminated histoplasmosis, a disease that can present years after exposure to the causative organism, may manifest in many diverse ways. Although the gastrointestinal tract is involved in most cases, the initial presentation occurring along the gastrointestinal tract, including the colon and rectum, is infrequent.Case Report:This case report describes a 66-year-old male patient who presented with an indurated painful perianal lesion that appeared highly suspicious for malignancy on imaging. The patient had no known history of well-established immunocompromised state except for a short course of prednisolone for chronic obstructive pulmonary disease management. A biopsy of the mass was performed, showing chronic inflammation with clusters of epithelioid histiocytes containing characteristic, PAS-fungus stain-positive, intracellular yeast forms consistent with histoplasmosis. There was no evidence of malignancy. A subsequent work-up revealed perihilar nodularity on chest X-ray suggestive of calcified granuloma, a positive Histoplasma Capsulatum Antigen test result, and mildly decreased CD4: CD8 ratio of unknown significance. HIV testing was negative. Treatment with itraconazole and terbinafine was initiated, and at 5-months follow-up, the patient reported significant improvement in signs and symptoms, with undetectable Histoplasma antigen on repeat testing.Conclusions:This case represents an extremely rare presentation of histoplasmosis infection, and highlights the fact that presenting symptoms of histoplasmosis can be vague and may mimic other disease processes, including neoplasia. Biopsy of the lesion with PAS staining and serologic testing is critical in establishing the correct diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis

et al. 2019

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“…Mullick et al reported a case in which a 69-year-old man presented with lower gastrointestinal bleeding. 11 The colonoscopy showed an anal mass mimicking squamous cell carcinoma on appearance. Biopsy of this mass showed Histoplasma on the periodic acid Schiff and Gomori methenamine silver stains.…”

mentioning

confidence: 99%

Progressive Disseminated Histoplasmosis Mimicking as Anal Carcinoma – Look at the Mountain, Not at Stone: A Case Report

Singh¹,

Sharma²,

Sankhala³

et al. 2021

JMDH

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Disseminated histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum . Here, we are presenting a case of shock who was diagnosed to have primary adrenal insufficiency. This 68-year-old man had bilateral adrenal mass and later presented with chronic fever and ulcerated anal mass in the oncology clinic. The oncologist made a provisional diagnosis of anal carcinoma with adrenal metastasis. He was suspected of having an adrenal crisis and was admitted to the intensive care unit. He also had granulomatous hepatitis and acute kidney injury. The working diagnosis was changed to systemic inflammatory/infective pathology. The biopsy of the anal tissue done to look for the aetiology showed Histoplasma . He was started on oral itraconazole therapy. He improved symptomatically (resolution of fever, improvement in pain) when assessed after seven days. His anal ulcer healed after 21 days of itraconazole therapy.

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Disseminated histoplasmosis with reactive hemophagocytosis: Aspiration cytology findings in two cases

2000

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Two cases of disseminated histoplasmosis associated with reactive hemophagocytic syndrome are described. The clinical presentation was with prolonged unexplained fever and hepatosplenomegaly. On a strong clinical possibility of tuberculosis, antitubercular treatment was initiated in both patients. Lymph node (case 1), splenic (case 2), and bone marrow aspiration, however, showed sheets of proliferating histiocytes, and intracellular and extracellular histoplasma organisms. Aspiration cytology was thus valuable in establishing the final diagnosis. The patients had a fulminant clinical course and died of hemorrhagic shock within 48 hr of hospital admission before specific therapy could be initiated. Histoplasmosis can mimic tuberculosis clinically. There is a need for an increased awareness of the clinicopathological spectrum of histoplasmosis, especially its rarer manifestations as hemophagocytic syndrome. In suspected cases, aspirations from the lymph node, liver, and spleen can be performed safely and should be utilized for early diagnosis. Diagn. Cytopathol. 2000;23:422–424. © 2000 Wiley‐Liss, Inc.

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Cytology of Gastrointestinal Histoplasmosis

Cited by 17 publications

References 11 publications

Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis

Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis

Progressive Disseminated Histoplasmosis Mimicking as Anal Carcinoma – Look at the Mountain, Not at Stone: A Case Report

Disseminated histoplasmosis with reactive hemophagocytosis: Aspiration cytology findings in two cases

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