title: Disseminated Histoplasmosis: A Challenging Differential Diagnostic Consideration for Suspected Malignant Lesions in the Digestive Tract.
abstract: Histoplasmosis is well characterized as an endemic fungal disease restricted to certain areas of the USA. In Middle Europe, most patients present with acute pulmonary symptoms after travelling to endemic areas. Here, we want to illustrate the case of a 67-year-old man who presented with persistent oral ulcers, hoarseness, dysphagia, diarrhea, and weight loss to our Department of Otorhinolaryngology in December 2014. He was a retired construction worker and had a history of soil-disruptive activities in Africa and Middle and South America during employment. A positron emission tomography-computed tomography scan revealed prominent hypermetabolic lesions in the cecum and the lung, pointing towards a malignant disease. Surprisingly, histological examination of colonic and oral biopsies revealed abundant intracellular fungal elements, highly suspicious ofHistoplasma capsulatum. Diagnosis was finally confirmed by panfungal polymerase chain reaction. Upon treatment with liposomal amphotericin followed by itraconazole, the severely ill patient showed an impressive clinical response. This case describes a disseminated manifestation ofH. capsulatumyears after the first exposure in an otherwise immunocompetent patient descending from a nonendemic area.
authors.affiliation: Department of Internal Medicine I, Hematology, Oncology and Gastroenterology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Doleschal
authors.affiliation: Department of Otorhinolaryngology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Therese
authors.initials: T
authors.lastname: Rödhammer
authors.affiliation: Department of Pathology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Oleksiy
authors.initials: O
authors.lastname: Tsybrovskyy
authors.affiliation: Department of Internal Medicine I, Hematology, Oncology and Gastroenterology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Aichberger
authors.affiliation: Department of Internal Medicine I, Hematology, Oncology and Gastroenterology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Lang
keywords: Colonic lesions; Disseminated histoplasmosis; Nonendemic area; Nonimmunocompromised patient; Oral ulcers; Systemic illness