Histoplasmosis of the small bowel in patients with AIDS

Abstract

Primary laryngeal amyloidosis is a rare benign disease of unknown aetiology. It can present with dysphonia or stridor. A woman presenting with airway compromise, who required a tracheostomy, is reported. (Postgrad Med J 2000;76:364-365) Keywords: laryngeal disease; amyloidosis Case report A 47 year old woman presented with a seven year history of dysphonia which had deteriorated recently. Fibre optic laryngoscopy showed polyps on the right false vocal cord with a suggestion of subglottic stenosis (fig 1). The true vocal cords were mobile and appeared normal.While awaiting further investigation, she presented with airway compromise requiring urgent tracheostomy. Direct laryngoscopy revealed subglottic oedema. The polypoid lesion was biopsied and showed features suggestive of amyloidosis and this was confirmed after staining with Congo red. A flexible bronchoscopy through the tracheostomy tube showed isolated nodules within the trachea (fig 2). Full blood count and erythrocyte sedimentation rates were normal.At follow up a year later she was noted to have a change in voice. Fibre optic laryngoscopy showed new lesions on the right and left true vocal cords. These were resected with a carbon dioxide laser. The result was a subjective improvement in the quality of her voice and airway. She was decannulated two months later. She remains under review and requires no further intervention. DiscussionAmyloidosis is a benign, slowly progressive condition that is characterised by extracellular fibular proteins. Diagnosis is confirmed by histopathological specimens that stain with Congo red.1 Amyloidosis can be classified as either primary, developing spontaneously, or secondary to some other longstanding inflammatory disease such as rheumatoid arthritis. The primary form can be further subdivided into a localised form, where deposits are confined to a single organ or location, or generalised, where deposits are found to some extent in all tissues.The most common presenting symptoms of primary laryngeal amyloidosis are dysphonia and stridor. Rarely, airway compromise occurs and an alternative airway may be necessary. The presence of tender bones, lymphadenopathy, or splenomegaly should alert the clinician to the possibility of generalised amyloidosis. Learning points x Amyloidosis is a rare benign disease of unknown aetiology. x Laryngeal amyloidosis can present with hoarseness or stridor which may require tracheostomy. x Histological diagnosis from a biopsy specimen can be confirmed with characteristic staining with Congo red. x Treatment is by surgical resection using the carbon dioxide laser. Repeated resections may be necessary. Localisation of lesions in the larynx is to the ventricle, false vocal cords, true vocal cords, aryepiglottic folds, and subglottis in that order of frequency.2 4 Histology of the biopsied specimen using routine haematoxylin and eosin stain shows amyloid as eosinophilic extracellular infiltrate. Further staining with Congo red reveals characteristic apple green birefringence with a ...

Gastrointestinal histoplasmosis mimicking peritonitis carcinomatosis: a rare case of an emergent surgical presentation of HIV de novo

“…Bowel obstruction has been reported in a number of case reports and series. This is the fourth case of small bowel perforation due to abdominal histoplasmosis in history [6, 9, 10]. Physicians may consider histoplasmosis in the differential diagnosis of a patient with peritonitis of unknown origin [6].…”

Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation

“…Several published cases and case series report ileal and colonic perforation. In 2000, Gumbs et al reported what they believed to be the first report of jejunal perforation [10]. A 2006 case series by Assi et al report 18 new cases of GI histoplasmosis.…”

“…Several case reports and case series have described bowel obstruction and, rarely, perforation, the most common sites being colon or ileum [2–9]. Jejunal perforation has been reported only three times in our literature review [2, 10, 11]. We hereby present an HIV patient presenting with an acute abdomen found to have diffuse jejunal and mesenteric disease.…”

Human T Lymphotropic virus-1 associated gastrointestinal histoplasmosis in Peru

“…Inflammatory masses mimicking a malignancy have been described in immunosuppressed patients with colonic obstruction [10]. Small bowel obstruction with segmental strictures and ulcerations has also been reported [11]. …”