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Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation

INTRODUCTION: Gastrointestinal histoplasmosis (GH) is a well-described albeit uncommon disease. It is found almost exclusively in the immunocompromised host, especially those with untreated HIV and low CD4 counts. Presentation with intestinal perforation is seen mostly commonly in the colon. We pres...

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Autores principales: Anderson, Bryan R., Marriott, Jaron, Bulathsinghala, Chinthaka, Anjum, Humayun, Surani, Salim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817307/
https://www.ncbi.nlm.nih.gov/pubmed/29535767
http://dx.doi.org/10.1155/2018/8923972
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author Anderson, Bryan R.
Marriott, Jaron
Bulathsinghala, Chinthaka
Anjum, Humayun
Surani, Salim
author_facet Anderson, Bryan R.
Marriott, Jaron
Bulathsinghala, Chinthaka
Anjum, Humayun
Surani, Salim
author_sort Anderson, Bryan R.
collection PubMed
description INTRODUCTION: Gastrointestinal histoplasmosis (GH) is a well-described albeit uncommon disease. It is found almost exclusively in the immunocompromised host, especially those with untreated HIV and low CD4 counts. Presentation with intestinal perforation is seen mostly commonly in the colon. We present a patient with jejunal perforation, and there have been only 3 previous cases reported in the literature. CASE: A 39-year-old male with known, untreated HIV presented to the ED with an acute abdomen after experiencing worsening intermittent abdominal pain for 2 months before that was associated with nausea, vomiting, diarrhea, and weight loss. CT of the abdomen and pelvis revealed evidence of gas in the mesentery, small bowel thickening, edema, and free fluid in the abdomen. Emergency exploratory laparotomy was conducted. Intraoperative findings included a perforated jejunum that was studded with nodular lesions as well as mesenteric masses. Histopathologic exam of these mesenteric masses and jejunal lesions were positive for histoplasmosis. CONCLUSION: Disseminated histoplasmosis is a life-threatening disease that occurs nearly exclusively in immunocompromised hosts. Untreated, mortality is as high as 80%. This rare presentation with jejunal perforation highlights the need for awareness of histoplasmosis involvement throughout the entirety of the GI tract.
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spelling pubmed-58173072018-03-13 Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation Anderson, Bryan R. Marriott, Jaron Bulathsinghala, Chinthaka Anjum, Humayun Surani, Salim Case Rep Med Case Report INTRODUCTION: Gastrointestinal histoplasmosis (GH) is a well-described albeit uncommon disease. It is found almost exclusively in the immunocompromised host, especially those with untreated HIV and low CD4 counts. Presentation with intestinal perforation is seen mostly commonly in the colon. We present a patient with jejunal perforation, and there have been only 3 previous cases reported in the literature. CASE: A 39-year-old male with known, untreated HIV presented to the ED with an acute abdomen after experiencing worsening intermittent abdominal pain for 2 months before that was associated with nausea, vomiting, diarrhea, and weight loss. CT of the abdomen and pelvis revealed evidence of gas in the mesentery, small bowel thickening, edema, and free fluid in the abdomen. Emergency exploratory laparotomy was conducted. Intraoperative findings included a perforated jejunum that was studded with nodular lesions as well as mesenteric masses. Histopathologic exam of these mesenteric masses and jejunal lesions were positive for histoplasmosis. CONCLUSION: Disseminated histoplasmosis is a life-threatening disease that occurs nearly exclusively in immunocompromised hosts. Untreated, mortality is as high as 80%. This rare presentation with jejunal perforation highlights the need for awareness of histoplasmosis involvement throughout the entirety of the GI tract. Hindawi 2018-01-08 /pmc/articles/PMC5817307/ /pubmed/29535767 http://dx.doi.org/10.1155/2018/8923972 Text en Copyright © 2018 Bryan R. Anderson et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Anderson, Bryan R.
Marriott, Jaron
Bulathsinghala, Chinthaka
Anjum, Humayun
Surani, Salim
Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title_full Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title_fullStr Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title_full_unstemmed Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title_short Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation
title_sort gastrointestinal histoplasmosis presenting as an acute abdomen with jejunal perforation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817307/
https://www.ncbi.nlm.nih.gov/pubmed/29535767
http://dx.doi.org/10.1155/2018/8923972
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