Panchabhai Tanmay S, Bais Rajeev K, Pyle Regan C, Mitchell Charlene K, Arnold Forest W
University of Louisville, Department of Medicine, Division of General Internal Medicine, Palliative Medicine and Medical Education, Louisville, KY 40202, USA.
J Glob Infect Dis. 2011 Apr;3(2):195-8. doi: 10.4103/0974-777X.81700.
Gastrointestinal involvement occurs in about 70% to 90% of histoplasmosis cases but is usually not the initial manifestation. We present the case of a 52-yearold HIV-positive woman who presented with gastrointestinal symptoms and an apple-core lesion on CT scan of the abdomen. The patient had been diagnosed with histoplasma colitis eight months earlier and was started on long-term itraconazole therapy. However, she prematurely discontinued treatment. A colonoscopy during the present hospitalization revealed a 3.5-cm mass, biopsies of which revealed Histoplasma capsulatum. In the present report, we discuss the differential diagnosis of apple-core lesions in the colon and the importance of keeping histoplasmosis on the differential diagnosis, especially in endemic areas like the Ohio River valley. It is equally important to ensure compliance with treatment of histoplasmosis, as well as close follow-up, as progression to colonic obstruction while on medical management has been reported.
胃肠道受累见于约70%至90%的组织胞浆菌病病例，但通常不是初始表现。我们报告一例52岁HIV阳性女性，她出现胃肠道症状，腹部CT扫描显示有苹果核样病变。该患者8个月前被诊断为组织胞浆菌性结肠炎，并开始接受长期伊曲康唑治疗。然而，她过早停药。本次住院期间的结肠镜检查发现一个3.5厘米的肿物，活检显示为荚膜组织胞浆菌。在本报告中，我们讨论了结肠苹果核样病变的鉴别诊断以及在鉴别诊断中考虑组织胞浆菌病的重要性，尤其是在俄亥俄河谷等流行地区。同样重要的是要确保组织胞浆菌病治疗的依从性以及密切随访，因为已有报道在药物治疗期间进展为结肠梗阻。
