Ileum Histoplasmosis Mimicking Intestinal Tuberculosis and Crohn's Disease

Abstract

Gastrointestinal histoplasmosis (GIH) without pulmonary and bone marrow involvement is very rare worldwide. It can be misdiagnosed as intestinal tuberculosis or Crohn's disease. There are just few case reports of GIH in patients with a positive HIV antibody test. Here, we report a patient who presented to our hospital with repeated intestinal obstruction. The suspicious diagnosis was intestinal tuberculosis or Crohn's disease due to unspecific clinical manifestations and radiologic images. Our patient's HIV antibody test was negative. She had no medical prescriptions. Therefore, our differential diagnosis needed to include ileum histoplasmosis besides intestinal lymphoma, intestinal tuberculosis, and Crohn's disease. Finally, the patient was diagnosed with ileum histoplasmosis due to surgical resection. It is important to be aware of potential infectious diseases, such as ileum histoplasmosis, when making a differential diagnosis. Moreover, surgical resection might be the final approach for small-intestine stricture with fibrosis.

Keywords: Crohn's disease; Ileum histoplasmosis; Intestinal tuberculosis.

Fig. 1.

Barium enema showing filling defects and a partial ileum stricture (arrows).

Fig. 2.

Small-bowel CT demonstrating bowel thickening, distal bowel dilation, and “comb” sign (arrows).

Fig. 3.

Surgical specimen showing ileum fibrosis and stenosis, and multiple cobblestone appearances (arrows).

Fig. 4.

a Diffused lymphohistiocytic infiltration and well-formed granulomas were observed microscopically (HE ×20) (arrows). b Periodic acid-Schiff staining revealed budding forms of histoplasma capsulatum within macrophages (HE ×40) (arrows).