Histoplasmosis-induced ileal perforation in a patient with acquired immune deficiency syndrome: Case report

Abstract

Intestinal involvement with disseminated histoplasmosis is common in some populations infected with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), especially in those who come from tropical zones. We report the case of a 29-year-old male patient, from a tropical zone, with HIV infection and a CD₄ value less than 50 cells/mm³, with a history of abdominal pain, fever, diarrhea, and weight loss. On presentation, he was pale, sweaty, and had abdominal rebound tenderness. Laboratory findings demonstrated microcitic hipocromic anemia, azoemia, and hypoalbuminemia. Abdominal-X-rays revealed pneumoperitoneum and air fluid levels. He underwent surgery, and a 1-cm perforation proximal to ileocecal valve was found. A resection and an ileostomy were performed. Histopathology identified caseating granulomas with yeast, compatible with histoplasmosis. He was treated with anfotericin B plus itraconazol with clinical improvement.

Keywords: histoplasmosis; human immunodeficiency virus; intestinal perforation.

Figure 1

(a) Abdominal X‐ray with pnemoperitoneum and air fluid levels. (b) Segment of small intestine. The large arrow indicates the location of the bowel perforation. The small arrow points to the fibrin layer that covers the intestinal serosa. (c) Hematoxylin–eosin (H–E) staining (400×) shows a macrophage with yeast of approximately 3 μm diameter, compatible with Histoplasma (arrow).