Histoplasmosis and inflammatory bowel disease: A case report

Abstract

BACKGROUND

Infection with Histoplasma capsulatum can lead to a disseminated disease involving the gastrointestinal tract presenting as diffuse abdominal pain and inflammatory diarrhea which may mimic inflammatory bowel disease (IBD).

CASE SUMMARY

In the current report, we discuss the case of a 41-year old male who presented to the emergency department with complaints of high-grade intermittent fevers and severe abdominal pain with associated diarrhea and hematochezia. Laboratory results demonstrated transaminitis and elevated erythrocyte sedimentation rate, C-reactive protein and ferritin levels. The patient’s presentation was thought to be an exacerbation of his underlying IBD, but further investigations revealed a positive Histoplasma antigen in the urine. The patient was offered a colonoscopy and biopsy to confirm the diagnosis; however, he refused. He was treated with itraconazole and showed significant improvement of his symptoms, thereby confirming the diagnosis of gastrointestinal histoplasmosis.

CONCLUSION

Here within, we provide a review of IBD, evaluation of chronic diarrhea, and gastrointestinal histoplasmosis.

Keywords: Histoplasmosis; Inflammatory bowel disease; Intestine; Endoscopy; Gastroenterology; Case report

Core Tip: Histoplasmosis can lead to a disseminating disease state affecting a large number of organ systems, leading to a wide range of pathology. This includes the gastrointestinal tract. We present herein, a case of gastrointestinal histoplasmosis in a patient with long standing ulcerative colitis that presented in a manner very similar to acute exacerbation of inflammatory bowel disease. This case highlights the importance of keeping gastrointestinal histoplasmosis amongst the differential diagnoses in cases that present similarly to acute exacerbation of inflammatory bowel disease in order to prevent inappropriate delays in diagnosis, unnecessary procedures, and increased morbidity and mortality.