Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Abstract

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.

Isolated Colonic Histoplasmosis in Patients Undergoing Immunomodulator Therapy: A Systematic Review

“…Nonetheless, the diagnostic confirmation was obtained from the histological examination of the biopsies or resected colonic specimens. Ekeng et al 47 conducted a descriptive review of gastrointestinal histoplasmosis from 2001 to 2021. Of the included 123 cases, 109 (88.6%) were diagnosed by histopathology.…”

Disseminated Histoplasmosis Causing Temporally and Spatially Discrete Gastrointestinal Perforations in an HIV-Negative Patient

“…The morphological and histopathological findings of endoscopic biopsies of patients undergoing investigation for inflammatory bowel disease (IBD) can mimic the findings of patients with GIH leading to misdiagnosis. 1 For those patients diagnosed with GIH, outcomes were positive in all cases treated with combination amphotericin B/azole and were positive in 96.6% of cases treated with azole monotherapy. 1 A review performed by Kauffman discussed that disseminated histoplasmosis is commonly found in the gastrointestinal tract during autopsy in previously asymptomatic or minimally symptomatic patients.…”

“…1 For those patients diagnosed with GIH, outcomes were positive in all cases treated with combination amphotericin B/azole and were positive in 96.6% of cases treated with azole monotherapy. 1 A review performed by Kauffman discussed that disseminated histoplasmosis is commonly found in the gastrointestinal tract during autopsy in previously asymptomatic or minimally symptomatic patients. In symptomatic patients, the large bowel is the most common site of involvement with lesser involvement in the small bowel.…”

“…In symptomatic patients, the large bowel is the most common site of involvement with lesser involvement in the small bowel. 1,2 Within the small bowel, the ileum is the most common location of ulceration. 1 A case report by Anderson et al discussing a jejunal perforation remarked that there are only 3 additional case reports of jejunal perforation as a result of GIH discussed in the literature.…”

“…1,2 Within the small bowel, the ileum is the most common location of ulceration. 1 A case report by Anderson et al discussing a jejunal perforation remarked that there are only 3 additional case reports of jejunal perforation as a result of GIH discussed in the literature. 3 A review of the literature does show evidence of gastrointestinal strictures, primarily ileal, in patients with histoplasmosis which have been shown to resolve with antifungal therapy which the authors believe explain the resolution of the previously seen multiple small bowel strictures.…”