A case report of gastrointestinal histoplasmosis in a patient treated with infliximab
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CASE REPORT
A case report of gastrointestinal histoplasmosis in a patient treated with infliximab Berta Oliveras1 · Marc Albert1 · Carme López1 · Esther Fort1 · Laia Peries1 · Laia Gutiérrez1 · David Busquets1 · Hugo Uchima1 · Xavier Aldeguer1 · Virginia Piñol1 Received: 20 February 2020 / Accepted: 6 November 2020 © Japanese Society of Gastroenterology 2020
Abstract Histoplasmosis is an endemic mycosis in some areas of North and South America. This disease is usually asymptomatic, but it can result in severe and disseminated infection involving gastrointestinal tract, especially in immunocompromised individuals. We report a case of a 33-years-old Ecuadorian male treated with infliximab who developed disseminated histoplasmosis with gastrointestinal affection. Due to the non-specific presentation of gastrointestinal histoplasmosis, the diagnosis is often delayed and it causes poor outcomes. It is important to consider this diagnosis in immunocompromised patients with compatible symptoms, like patients on TNF inhibitors. Keywords Gastrointestinal histoplasmosis · Infliximab · Case report
Background
Case presentation
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. This mycosis is endemic in some areas of North and South America like Ecuador; but we can encounter it in non-endemic countries because of the most frequent international travel and migration [1–3]. Most infections are asymptomatic (90–95%), but some individuals can develop clinical manifestations. The clinical affectation is mostly pulmonary (acute or chronic) but it can also cause a severe and progressive disseminated infection (it occurs in about one in 2000 patients with acute infection). Immunocompromised individuals (e.g., HIV-infected patients with low CD4 counts or patients using immunosuppressive therapies, including biologics) have more risk of developing this disseminated infection [4–7]. Disseminated histoplasmosis has histological involvement of the gastrointestinal tract in 70% of patients, but less than 10% of these cases have gastrointestinal manifestations [7, 8]. We report a case of disseminated Histoplasmosis in a young patient from Ecuador treated with Infliximab.
We present a 33-years-old Ecuadorian male. He had been diagnosed with juvenile idiopathic arthritis (associated with the presence of HLA-B27) at 11-years-old. He started treatment with anti-TNF (Infliximab) at 2016. The current disease begins in December 2017, coinciding with a trip to Ecuador of our patient. There, he started with diarrhea and abdominal pain without fever. When he came back, he continued with intermittent diarrhea and abdominal pain with signs of intestinal obstruction. He also had fever and hematochezia. He lost 25 kilos in 4 months. The abdominal CT scan, done in his reference center, showed diffuse and circumferencial bowel thickening of the splenic flexure. Then, it was performed a colonoscopy, seeing the colon stricture with associated ulcerations, from where biopsies were taken. The anatomopathological study showed the pre
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