Disseminated histoplasmosis involving the gastrointestinal tract. A case report

Abstract

A 55-year-old woman with a history of childhood tuberculosis, long-term exposure to poultry, and current management of hypertension and type 2 diabetes mellitus presented with clinical symptoms of abdominal pain and a palpable mass in the epigastrium associated with fever, without other symptoms. Plain and contrast-enhanced abdominal CT revealed a neoplastic-appearing mass in the stomach involving all layers and invading the right abdominal rectus with metastatic-looking lymphadenopathy around the mass. Upper gastrointestinal endoscopy reported extrinsic compression, and surgical intervention revealed findings of a neoplastic inflammatory mass involving the greater curvature of the distal stomach, omentum, and transverse colon, necessitating subtotal gastrectomy. Postoperatively, multiple abdominal collections required percutaneous surgical management and antibiotic therapy, with a complicated clinical course.

Finally, the pathological examination of the subtotal gastrectomy biopsy was negative for malignancy, revealing incidental findings of chronic granulomatous inflammation with negative Ziehl-Neelsen staining and intracellular yeast forms compatible with Histoplasma capsulatum. Treatment with amphotericin B led to subsequent resolution of the case. The atypical presentation in an immunocompetent patient posed diagnostic challenges, mimicking malignant gastric neoplasia clinically. We present a case of unusual gastrointestinal histoplasmosis in an immunocompetent woman in Popayán, Colombia.