Anderson Bryan R, Marriott Jaron, Bulathsinghala Chinthaka, Anjum Humayun, Surani Salim
Bay Area Medical Center, Corpus Christi, TX, USA.
Texas A&M University, College Station, TX, USA.
Case Rep Med. 2018 Jan 8;2018:8923972. doi: 10.1155/2018/8923972. eCollection 2018.
Gastrointestinal histoplasmosis (GH) is a well-described albeit uncommon disease. It is found almost exclusively in the immunocompromised host, especially those with untreated HIV and low CD4 counts. Presentation with intestinal perforation is seen mostly commonly in the colon. We present a patient with jejunal perforation, and there have been only 3 previous cases reported in the literature.
A 39-year-old male with known, untreated HIV presented to the ED with an acute abdomen after experiencing worsening intermittent abdominal pain for 2 months before that was associated with nausea, vomiting, diarrhea, and weight loss. CT of the abdomen and pelvis revealed evidence of gas in the mesentery, small bowel thickening, edema, and free fluid in the abdomen. Emergency exploratory laparotomy was conducted. Intraoperative findings included a perforated jejunum that was studded with nodular lesions as well as mesenteric masses. Histopathologic exam of these mesenteric masses and jejunal lesions were positive for histoplasmosis.
Disseminated histoplasmosis is a life-threatening disease that occurs nearly exclusively in immunocompromised hosts. Untreated, mortality is as high as 80%. This rare presentation with jejunal perforation highlights the need for awareness of histoplasmosis involvement throughout the entirety of the GI tract.
胃肠道组织胞浆菌病（GH）虽不常见，但已有详细描述。它几乎仅见于免疫功能低下的宿主，尤其是那些未接受治疗且CD4计数低的HIV感染者。肠道穿孔最常出现在结肠。我们报告一例空肠穿孔患者，此前文献中仅报道过3例。
一名39岁已知未接受治疗的HIV男性患者，在经历了2个月间歇性腹痛加重后，因急腹症就诊于急诊科，腹痛伴有恶心、呕吐、腹泻和体重减轻。腹部和盆腔CT显示肠系膜有气体、小肠增厚、水肿以及腹腔内有游离液体。进行了急诊剖腹探查术。术中发现包括一个布满结节状病变的空肠穿孔以及肠系膜肿块。这些肠系膜肿块和空肠病变的组织病理学检查显示组织胞浆菌病呈阳性。
播散性组织胞浆菌病是一种几乎仅发生在免疫功能低下宿主中的危及生命的疾病。若不治疗，死亡率高达80%。这种罕见的空肠穿孔表现凸显了对整个胃肠道受累的组织胞浆菌病提高认识的必要性。
