title: Colonic involvement in disseminated histoplasmosis of an immunocompetent adult: case report and literature review.
abstract: BACKGROUND
  Histoplasmosis is a common opportunistic fungal infection that is observed almost exclusively in immunodeficient patients, especially those with AIDS. Immunocompetent individuals that suffer from histoplasmosis are rarely reported, especially those with disseminated lesions, such as disseminated histoplasmosis. The observation of disseminated histoplasmosis with prominent gastrointestinal involvement, no respiratory symptoms (which is presumed to be the portal of infection), gastrointestinal pathological changes, and minor digestive system disorders make this case study exceedingly rare.
  
  
  METHODS
  We report the case of a 33-year-old immunocompetent male who presented with fever and weight loss. Based on investigations, the patient showed pancytopenia, hepatosplenomegaly, bone marrow involvement and marked colonic involvement. Finally, disseminated histoplasmosis was diagnosed and confirmed by stained smears of fine needle aspirates and biopsy from lesions in the bone marrow and colon. The patient showed appreciable regression of lesions following prompt treatment with amphotericin B deoxycholate, and was treated thereafter with oral itraconazole following discharge from hospital.
  
  
  CONCLUSIONS
  Disseminated histoplasmosis could be underestimated in immunocompetent patients. A high degree of clinical suspicion is essential in both immunocompromised and immunocompetent patients, regardless of pulmonary symptoms, and whether in endemic or non-endemic areas. Early and accurate diagnosis is extremely important for the appropriate treatment of infection and to improve disease outcome.
authors.affiliation: Center of Infectious Diseases, Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy (Sichuan University), West China Hospital, Sichuan University, NO, 37, Guoxue lane, Wuhou District, Chengdu 610041, China.
authors.forename: Biwei
authors.initials: B
authors.lastname: Yang
authors.forename: Lixia
authors.initials: L
authors.lastname: Lu
authors.forename: Dajiang
authors.initials: D
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Libin
authors.initials: L
authors.lastname: Huang
authors.forename: Liyu
authors.initials: L
authors.lastname: Chen
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
authors.forename: Lichun
authors.initials: L
authors.lastname: Wang
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology; D003106:Colon / Q000737:chemistry / Q000473:pathology*; D003108:Colonic Diseases / Q000175:diagnosis / Q000276:immunology / Q000473:pathology*; D004724:Endoscopy; D006660:Histoplasmosis / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007121:Immunocompetence; D008297:Male