GI Tuberculosis and Histoplasmosis in an HIV (+) Patient Presenting with Lower GI Bleeding

Piscoya, Alejandro; Cheng, Hugo Cedrón; Huerta-Mercado, Jorge; Valdivia, José Luis Pinto; Llach, Juan Carlos Ferrufino; Rivera, Alejandro Bussalleu

doi:10.1111/j.1572-0241.2005.41983_7.x

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…Failures of itraconazole therapy in AIDS patients who had coinfection with histoplasmosis and TB have been reported. 4,[9][10][11] There are several treatment alternatives that could perhaps obviate this drug-drug interaction, but most are not acceptable. For example, rifabutin could be used in place of rifampicin, but it also decreases the serum concentration of itraconazole 23 and is not available in many of the countries in which these infections occur.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Agudelo¹,

Restrepo²,

Molina³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

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Section: Discussionmentioning

confidence: 99%

“…A limited number of case reports dealing with problems of diagnosis or treatment has been published previously. 4,[9][10][11][12][13] We report our experience with a series of HIV-infected patients who had TB and histoplasmosis coinfection.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Agudelo¹,

Restrepo²,

Molina³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…Investigation revealed an ulcer as the source of bleeding, and its cause was a rare and unexpected coinfection by histoplasmosis and tuberculosis, making this a diagnostic and treatment challenge. The only well documented case that has been published up to now with a similar presentation was in an HIV patient with advanced disease [5]; to our knowledge, there are no reported cases in transplant patients.…”

Section: Discussionmentioning

confidence: 91%

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Oliveira¹,

Santana²,

Malave³

et al. 2018

JPP

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Abstract:Introduction: Histoplasmosis is a rare infectious condition caused by the fungus Histoplasma capsulatum that can be presented from asymptomatic to severe forms. Tuberculosis, still an endemic infection in some developing countries, can also have variable clinical presentations. Both diseases involve the lungs mostly, but in immunocompromised patients, especially those with advanced HIV infection and transplant patients, disseminated forms are more frequently found. Gastrointestinal involvement is unusual, and digestive bleeding is an even rarer complication. Case presentation: We report the case of a 39-year-old female who was diagnosed with a Mycobacterium tuberculosis and Histoplasma capsulatum coinfection occurring 11 years after a living-donor-related renal transplant. The patient presented a severe gastrointestinal bleeding caused by an ulcer in the ascending colon. She improved after a combined treatment with tuberculostatic and fungicidal drugs. Conclusions: Simultaneous gastrointestinal involvement by histoplasmosis and tuberculosis, presenting as severe digestive bleeding, with minimal respiratory symptoms associated, make this an extremely rare case and a diagnostic challenge. Therefore, it is important to keep a high clinical suspicion of opportunistic infection, especially in immunocompromised patient who presents with LGB.

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“…Moreover, even in immunocompromised patients, colonic involvement with histoplasmosis is rare [1, 7, 8]. Previous cases with colitis due to coinfections with histoplasmosis have been reported in immunocompromised patients (AIDS); Fan et al [9] reported a 45-year-old man with colitis mimicking carcinoma caused by Histoplasma and cytomegalovirus, and Piscoya-Rivera et al [10] reported a young man with lower gastrointestinal bleeding and coexistence of Histoplasma and Mycobacterium tuberculosis. In our case, the patient did not have any major immunocompromising conditions such as AIDS, chemotherapy, or immunosuppressive therapy, although we did not measure serum levels of immunoglobulin nor CD4/CD8 counts.…”

Section: Discussionmentioning

confidence: 99%

Dimorphic Fungal Coinfection as a Cause of Chronic Diarrhea and Pancolitis

Bravo

Zegarra

Piscoya

et al. 2011

Case Reports in Medicine

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Histoplasma capsulatum and Paracoccidioides brasiliensis are dimorphic fungi that cause systemic mycosis mostly in tropical South America and some areas of North America. Gastrointestinal involvement is not uncommon among these fungal diseases, but coinfection has not previously been reported. We report a patient with chronic diarrhea and pancolitis caused by paracoccidioidomycosis and histoplasmosis.

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GI Tuberculosis and Histoplasmosis in an HIV (+) Patient Presenting with Lower GI Bleeding

Cited by 6 publications

References 3 publications

Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Dimorphic Fungal Coinfection as a Cause of Chronic Diarrhea and Pancolitis

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