Disseminated histoplasmosis in a patient with Crohn's disease on dual immunosuppression

MacIsaac, Michael; Fehily, Sasha; Muhi, Stephen; Yang, Limin; McKelvie, Penelope; Jeremiah, Cameron; Demediuk, Barbara

doi:10.5694/mja2.50298

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…This plethora of presentations could be misleading and asnon-specific often led to delays in the treatment of patients with GIH.- The initial misdiagnosis was often malignancy [ 80 , 83 , 108 , 112 ], inflammatory bowel disease [ 21 , 33 , 40 , 52 , 69 , 89 , 105 , 107 , 116 ] or acute exacerbation of inflammatory bowel disease for patients already on immunosuppressants [ 29 , 30 , 32 , 37 , 53 , 81 ] or tuberculosis [ 85 , 96 , 102 ]. As a result of delay, some patients experienced worsening clinical states [ 33 , 69 , 89 , 105 , 107 , 116 ] and/or death [ 20 , 80 , 100 , 116 , 122 ]. A high index of suspicion in evaluating GIH in patients is needed as this will reduce the incidence of complications, such as lower gastrointestinal bleeding [ 17 , 26 , 27 , 29 , 30 , 31 , 33 , 39 , 44 , 53 , 56 , 59 , 63 , 70 , 84 , 94 , 102 , 103 , 105 , ...…”

Section: Discussionmentioning

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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