Abstract
Histoplasmosis is a self-limiting and asymptomatic disease in immunocompetent individuals. Patients in an immunocompromised state are susceptible to disseminated disease. We present a case of a 60-year-old male with a history of psoriatic and rheumatoid arthritis treated with a tumor necrosis factor inhibitor (adalimumab), who presented with abdominal pain and was found to have gastrointestinal histoplasmosis as an obstructing ileocecal mass. Although gastrointestinal involvement is common in disseminating disease, symptomatic involvement is rare. This case presentation has implications in rheumatological patients on biologic medications.
Highlights
Histoplasmosis is a fungal infection endemic to the Ohio River valley [1]
Patients that are faced with the disseminated disease include those that are in an immunocompromised state, including patients with HIV/AIDS, recipients of bone marrow or organ transplantation, those on tumor necrosis factor inhibitors, those taking corticosteroids, patients with genetic diseases, and patients with hematologic cancers [4]
We present a case of an elderly male with disseminated histoplasmosis with prominent manifestations of the small bowel and colonic involvement
Summary
Histoplasmosis is a fungal infection endemic to the Ohio River valley [1] It can present clinically in many ways, including asymptomatic, acute and chronic pulmonary infections, or disseminated disease. An abdominal CT scan (Figure 3) was obtained and showed high-grade small bowel obstruction at the terminal ileum and a possible cecal mass. He was taken to the operating room for surgery to remove the ileocecal mass (Figure 4) and had a laparoscopic assisted right colectomy with end ileostomy. The patient was started on intravenous amphotericin b and transitioned to a two-week course of itraconazole He progressed as expected and was safely discharged home
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