Abstract
A 43-year-old male has a medical history of Human immunodeficiency virus (HIV) with no anti-retroviral therapy for six years prior to admission. He presented from an outside hospital with 40 lbs weight loss over one year, worsening abdominal pain, and odynophagia, with CT-confirmed small bowel obstruction (SBO) in the setting of untreated cytomegalovirus (CMV) ileitis. Treatment for both the untreated HIV and CMV ileitis was started during this hospitalization, and his hospital course was complicated by disseminated histoplasmosis in his lungs and GI tract, leading to stricture and a recurrent SBO. This case report will focus on an unusual complication of untreated HIV and a late diagnosis of histoplasmosis: Histoplasma ileitis-induced stricture and recurrent SBO. To date, there are a limited number of reports that describe gastrointestinal histoplasmosis in HIV patients, and SBO remains a rare and serious complication of disseminated histoplasmosis.
Highlights
Histoplasma capsulatum is endemic to North America, Central America, and many countries of South America and occurs in China, India, Southeast Asia, Africa, Australia, and Europe [1]
We present an unusual case of a 43-year-old male with untreated Human immunodeficiency virus (HIV), who was diagnosed with histoplasmosis in his terminal ileum, which leads to a rare complication of recurrent high-grade small bowel obstruction (SBO)
In our patient’s case, it is unclear why Histoplasma was not detected during the first biopsy at the outside hospital, it can be speculated that GI histoplasmosis was not on the differential since there was high suspicion for inflammatory bowel disease (IBD), and the tissue was not stained for Histoplasma capsulatum
Summary
Histoplasma capsulatum is endemic to North America, Central America, and many countries of South America and occurs in China, India, Southeast Asia, Africa, Australia, and Europe [1]. A 43-year-old male from Guatemala presented as a direct admission for untreated HIV complicated by cytomegalovirus (CMV) ileitis, 40 lb weight loss over one year, worsening abdominal pain, and odynophagia. The patient’s labs were notable for the following: Creatinine (Cr) 0.63 mg/dL, white blood cells (WBC) 3.8 10e9/L, Hgb 10 g/dL, MCV 77.5 fl, Platelet 341 10e9/L, absolute lymphocyte 0.7 10e9/L, CD4 47, HIV viral load 150,000, alkaline phosphatase 279 IU/L, AST 67 U/L He stopped smoking 30+ years ago, denied alcohol use, and current use of methamphetamine, and stated that he was currently only sexually active with his wife. The patient developed worsening abdominal pain and a CT abdomen/pelvis at that time demonstrated markedly dilated distended loops of small bowel with decompressed loops of ileum and colon consistent with a high-grade SBO. Due to the patient’s move outside of our healthcare system, no follow-up about his treatment progress is available
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