Digestive Diseases and Sciences

, Volume 33, Issue 3, pp 353–360 | Cite as

Gastrointestinal histoplasmosis

  • Mitchell S. Cappell
  • William Mandell
  • Margaret M. Grimes
  • Harold C. Neu
Review Article

Abstract

Three cases are reported of gastrointestinal histoplasmosis in patients who came from the Caribbean or South America and had lymphoma, acquired immunodeficiency syndrome, and prior local radiation therapy. The patients had small-bowel obstruction with ileal involvement, mucosal erythema, and friability on colonoscopy with colonic involvement and an exophytic rectal mass with rectal involvement. Review of the 77 reported cases of gastrointestinal histoplasmosis shows that this is a clinical subset of disseminated histoplasmosis. With gastrointestinal involvement, pulmonary symptoms are uncommon and gastrointestinal symptoms predominate. Fever is less common than in other forms of dissemination. The most common lesions are a mass or ulcers, which often mimic inflammatory bowel disease or carcinoma. Terminal ileal involvement predominates in one third. The complement fixation test was positive in about three quarters of cases tested, but the skin test is not diagnostic ally useful. In one quarter of patients there is other evidence of immunosuppression. In the immunosuppressed, gastrointestinal histoplasmosis must be considered, even in a patient from a nonendemic area, who presents with lesions appearing like carcinoma or inflammatory bowel disease. When feasible, endoscopic examination and biopsy with stains and culture for histoplasmosis is recommended for diagnosis. Medical management is recommended, with surgery reserved for acute emergencies or when mandatory for diagnosis.

Key words

gastrointestinal histoplasmosis small-bowel obstruction inflammatory bowel disease colonic, neoplasm dysphagia mediastinal histoplasmosis radiation colitis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Parsons RJ, Zarafonetis CDJ: Histoplasmosis in man: Report of seven cases and a review of seventy-one cases. Arch Intern Med 75:1–23, 1945Google Scholar
  2. 2.
    Goodwin RA, Shapiro JL, Thurman GH, Thurman SS, des Prez RM: Disseminated histoplasmosis: Clinical and pathologic correlations. Medicine 59:1–33, 1980PubMedGoogle Scholar
  3. 3.
    Smith JW, Utz JP: Progressive disseminated histoplasmosis: a prospective study of 26 patients. Ann Intern Med 76:557–565, 1972PubMedGoogle Scholar
  4. 4.
    Sarosi GA, Voth DW, Dahl BA, Doto IL, Tosh FE: Disseminated histoplasmosis: Results of long-term follow-up. Ann Intern Med 75:511–516, 1971PubMedGoogle Scholar
  5. 5.
    Reddy R, Gorelick DF, Brasher CA, Larsh H: Progressive disseminated histoplasmosis as seen in adults. Am J Med 48:629–636, 1970PubMedGoogle Scholar
  6. 6.
    Furcolow ML, Doto IL, Tosh FE, et al: Course and prognosis of untreated histoplasmosis. JAMA 177:292–296, 1961PubMedGoogle Scholar
  7. 7.
    Wheat LJ, Slama TG, Eitzen HE, Kohler RB, French MLV, Biesecker JL: A large urban outbreak of histoplasmosis: Clinical features. Ann Intern Med 94:331–337, 1981PubMedGoogle Scholar
  8. 8.
    Darling ST: Histoplasmosis: A fatal infectious disease resembling kala-azar found among natives of tropical America. Arch Intern Med 2:107–123, 1908Google Scholar
  9. 9.
    Henderson RG, Pinkerton H, Moore LT:Histoplasma capsulatum as a cause of chronic ulcerative colitis. JAMA 118:885–889, 1942Google Scholar
  10. 10.
    Levine V: Intestinal histoplasmosis. Proc Inst Med Chicago 15:70, 1944 (letter)Google Scholar
  11. 11.
    Raftery A, Trafas P, McClure RD: Histoplasmosis: A common cause of appendicitis and mesenteric adenitis. Ann Surg 132:720–728, 1950PubMedGoogle Scholar
  12. 12.
    Fischer H, Marks AR, Wilson JE, Hathaway R: Histoplasmosis. W Va Med J 47:114–119, 1951Google Scholar
  13. 13.
    Murray JF, Brandt FA: Histoplasmosis and malignant lymphoma. Am J Pathol 27:783–795, 1951PubMedGoogle Scholar
  14. 14.
    Morgan HJ, Shapiro J: Clinicopathologic conference: Gastrointestinal histoplasmosis. Tenn State Med Assoc J 45:488–491, 1952Google Scholar
  15. 15.
    Weiss ED, Haskeil BF: Anorectal manifestations of histoplasmosis. Am J Surg 84:541–544, 1952PubMedGoogle Scholar
  16. 16.
    Fitzpatrick TJ, Neiman BH: Histoplasma capsulatum infection associated with gastric ulcer and fatal hemorrhage. Arch Intern Med 91:49–55, 1953Google Scholar
  17. 17.
    Shull HJ: Human histoplasmosis: A disease with protean manifestations often with digestive system involvement. Gastroenteroiogy 25:582–595, 1953Google Scholar
  18. 18.
    Bersack SR, Howe JS, Rabson AS: Inflammatory pseudopolyposis of the small and large intestines with the Peutz-Jeghers syndrome in a case of diffuse histoplasmosis. Am J Roentgenol 80:73–78, 1958Google Scholar
  19. 19.
    Carmona MG, Allen MS: Recurrent intussusception in a six-year-old child with histoplasmosis of Peyer's patches. J Fla Med Assoc 44:955–956, 1958PubMedGoogle Scholar
  20. 20.
    Bank S, Trey C, Gans I, Marks IN, Groll A: Histoplasmosis of the small bowel with giant intestinal villi and secondary protein-losing enteropathy. Am J Med 39:492–501, 1965PubMedGoogle Scholar
  21. 21.
    Hinshaw RJ, Guilfoil PH: Roentgenogram of the month. Dis Chest 47:555–556, 1965PubMedGoogle Scholar
  22. 22.
    Sturim HS, Kouchoukos NT, Ahlvin RC: Gastrointestinal manifestations of disseminated histoplasmosis. Am J Surg 110:435–440, 1965PubMedGoogle Scholar
  23. 23.
    Nudelman HL, Rakatansky H: Gastric histoplasmosis. JAMA 195:44–46, 1966PubMedGoogle Scholar
  24. 24.
    Perez CA, Sturim HS, Kouchoukos NT, Kamberg S: Some clinical and radiographic features of gastrointestinal histoplasmosis. Radiology 86:482–487, 1966PubMedGoogle Scholar
  25. 25.
    Dietz MW: Ileocecal histoplasmosis. Radiology 91:285–289, 1968PubMedGoogle Scholar
  26. 26.
    Mohanty SK, Reddy P, Polk JW: Acute small bowel obstruction from disseminated histoplasmosis. Mo Med 67:100–103, 1970PubMedGoogle Scholar
  27. 27.
    Soper RT, Silber DL, Holcomb GW: Gastrointestinal histoplasmosis in children. J Pediatr Surg 5:32–39, 1970PubMedGoogle Scholar
  28. 28.
    Kirk ME, Lough J, Warner HA:Histoplasma colitis: An electron microscopic study. Gastroenteroiogy 61:46–54, 1971Google Scholar
  29. 29.
    Lee KR, Lin F: Gastrointestinal histoplasmosis, roentgenographic, clinical and pathological correlation. Am J Gastroenterol 63:255–265, 1975PubMedGoogle Scholar
  30. 30.
    Jenkins DW, Fisk DE, Byrd RB: Mediastinal histoplasmosis with esophageal abscess. Gastroenteroiogy 70:109–111, 1976Google Scholar
  31. 31.
    Haws CC, Long RF, Caplan GE:Histoplasma capsulatum as a cause of ileocolitis. Am J Roentgenol 128:692–694, 1977Google Scholar
  32. 32.
    Fisher JR, Sanowski RA: Disseminated histoplasmosis producing hypertrophic gastric folds. Dig Dis Sci 23:282–285, 1978Google Scholar
  33. 33.
    Hull PR: Systemic histoplasmosis with oesophageal obstruction due toHistoplasma granulomas: Successful treatment with rifampicin and amphotericin B. S Afr Med J 55:639–640, 1979PubMedGoogle Scholar
  34. 34.
    Miller DP, Everett ED: Gastrointestinal histoplasmosis. J Clin Gastroenterol 1:233–236, 1979PubMedGoogle Scholar
  35. 35.
    Rabinowitz JG, Prater W, Silver J, Phillips JC, Wieder S: Mediastinal histoplasmosis. Mt Sinai J Med 47:356–363, 1980PubMedGoogle Scholar
  36. 36.
    Gilliland MD, Scott LD, Walker WE: Esophageal obstruction caused by mediastinal histoplasmosis: Beneficial results of operation. Surgery 95:59–62, 1984PubMedGoogle Scholar
  37. 37.
    Haggerty CM, Britton MC, Dorman JM, Marzoni FA: Gastrointestinal histoplasmosis in suspected acquired immunodeficiency syndrome. West J Med 143:244–246, 1985PubMedGoogle Scholar
  38. 38.
    Lee SH, Barnes WG, Hodges GR, Dixon A: Perforated granulomatous colitis caused byHistoplasma capsulatum. Dis Colon Rectum 28:171–176, 1985PubMedGoogle Scholar
  39. 39.
    Alberti-Flor JJ, Granda A: Ileocecal histoplasmosis mimicking Crohn's disease in a patient with Job's syndrome. Digestion 33:176–180, 1986PubMedGoogle Scholar
  40. 40.
    Chretien JH, Garagusi VF: Current management of fungal enteritis. Med Clin North Am 66:675–687, 1982PubMedGoogle Scholar
  41. 41.
    Lehmann PF, Gibbons J, Senitzer D, Ribner BS, Freimer EH: T lymphocyte abnormalities in disseminated histoplasmosis. Am J Med 75:790–794, 1983PubMedGoogle Scholar
  42. 42.
    Christie A, Peterson JC: Pulmonary calcification in negative reactors to tuberculin. Am J Public Health 35:1131–1147, 1945Google Scholar
  43. 43.
    Nelson NA, Goodman HL, Oster HL: The association of histoplasmosis and lymphoma. Am J Med Sci 233:56–65, 1957PubMedGoogle Scholar
  44. 44.
    Bradsher RW, Alford RH, Hawkins SS, Spickard WA: Conditions associated with relapse of amphotericin Btreated disseminated histoplasmosis. John Hopkins Med J 150:127–131, 1982Google Scholar
  45. 45.
    Symoens J, Moens M, Dom J, Scheijgrond H, Dony J, Schuermans V, Legendre R, Finestine N: An evaluation of two years of clinical experience with ketoconazole. Rev Infect Dis 2:674–687, 1980PubMedGoogle Scholar
  46. 46.
    Hawkins SS, Gregory DW, Alford RH: Progressive disseminated histoplasmosis: Favorable response to ketoconazole. Ann Intern Med 95:446–449, 1981PubMedGoogle Scholar
  47. 47.
    Mabey DCW, Ajdukiewicz AB, Hay RJ: Treatment of African histoplasmosis with ketoconazole. J Trop Med Hyg 77:219–220, 1983Google Scholar
  48. 48.
    Slama TG: Treatment of disseminated and progressive cavitary histoplasmosis with ketoconazole. Am J Med 74(1B):70–73, 1983PubMedGoogle Scholar
  49. 49.
    Dismukes WE, Cloud G, Bowles C, et al: Treatment of blastomycosis and histoplasmosis with ketoconazole. Ann Intern Med 103:861–872, 1985PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Mitchell S. Cappell
    • 1
    • 2
  • William Mandell
    • 1
    • 2
  • Margaret M. Grimes
    • 1
    • 2
  • Harold C. Neu
    • 1
    • 2
  1. 1.Division of Gastroenterology, Department of MedicineAlbert Einstein College of MedicineNew York
  2. 2.Departments of Medicine and PathologyColumbia Presbyterian Medical CenterNew York

Personalised recommendations