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Case Reports in Gastrointestinal Medicine
Volume 2012 (2012), Article ID 515872, 4 pages
http://dx.doi.org/10.1155/2012/515872
Case Report

Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient

1Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN 37232-2582, USA
2Division of Infectious Diseases, Vanderbilt University School of Medicine, A2200 MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USA
3Vanderbilt Institute for Global Health (VIGH), 2525 West End Avenue, Suite 750, Nashville, TN 37203-1738, USA

Received 28 July 2012; Accepted 16 September 2012

Academic Editors: D. C. Damin, Y. Nakayama, and S. Nomura

Copyright © 2012 Michael A. Spinner et al. 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.

Abstract

Gastrointestinal histoplasmosis (GIH) is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts  cells/mm3) who reside in endemic areas (Ohio or Mississippi river valleys) and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole.