Some Clinical and Radiographic Features of Gastrointestinal Histoplasmosis

Abstract

Since the original description of the Histoplasma capsulatum by Darling in 1906 (4), involvement of the gastrointestinal tract in disseminated histoplasmosis has been observed frequently in autopsy material (13). Symptoms referable to the digestive system have been found in as many as 20 per cent of patients with histoplasmosis (14), but cases in which the gastrointestinal symptoms dominate the clinical picture are rare. The purpose of this article is to describe the clinical and radiographic findings in 5 cases of gastrointestinal histoplasmosis, 4 of which required surgery because of pre-operative clinical and roentgenographic changes. These patients were treated at Barnes Hospital and the Veterans Administration Hospital, St. Louis, Mo., from 1953 to 1965. The age of the patients varied from thirty-four to seventy-two years with an average of fifty-seven and eight-tenths years. Four were men, and one a woman. The surgical implications in 4 of the cases are reported elsewhere (19). The anatomical location of the lesions is shown in Table I. Clinical Features The 5 patients were all chronically ill, the duration of illness varying from four months to five years. Increasing fatig-ability, weight loss, anorexia, and cramping abdominal pain were usually present. Other specific gastrointestinal symptoms were dysphagia in the patient with the gastric lesion, constipation in two cases, and watery diarrhea in one with colonic involvement. Three of the patients presented with acute abdominal problems: uncontrollable gastrointestinal hemorrhage, perforations and peritonitis, and intestinal obstruction. Fever was present in only 2 instances. Palpable lymph nodes of varying size were described in 4 patients in the cervical, axillary, and∕or inguinal regions. In one patient, an associated malignant lymphoma was found. Hepatic and∕or splenic enlargement was an inconstant finding, observed in 3 patients. A severe hemorrhagic tendency, seen in one case, has occasionally been described with disseminated histoplasmosis (18). Laboratory Examinations: Invariably there was some degree of anemia, usually of the microcytic hypochromic type. The hemoglobin fell as low as 6 g. per 100 ml in 2 instances. Marked leukopenia was noted in 2. This finding has been reported in 50–60 per cent of patients with disseminated histoplasmosis (18). Guaiac reaction in stools was positive in only 2 cases, negative in 2, and unknown in 1. The histoplasmin skin test was negative in all 5 patients, but a complement fixation test was positive in the two instances in which it was carried out. A sputum smear and culture failed to demonstrate the organism in 4 patients in whom it was performed. Bone-marrow aspiration demonstrated the organism in 2 cases.