Kenneda Taylor Brooke, Willard Teagan L, Demkowicz Ryan, Willard Megan
Division of Gastroenterology and Hepatology, Department of Medicine, West Virginia University, Morgantown, WV, USA.
Biochemistry Department, Davis College of Agriculture and Natural Resources, West Virginia University, Morgantown, WV, USA.
Am J Case Rep. 2025 May 30;26:e948028. doi: 10.12659/AJCR.948028.
BACKGROUND Patients with HIV/AIDS can develop opportunistic infections of the esophagus. While Candida frequently causes infectious esophagitis in this population, other opportunistic infections, like cytomegalovirus and herpes simplex virus, can cause esophagitis, and in some cases, esophageal ulcers. Less frequent opportunistic infections of the esophagus include histoplasmosis. CASE REPORT A 58-year-old man with a history of HIV presented to the hospital with esophageal dysphagia. He had a history of disseminated histoplasmosis and was on itraconazole. Upper endoscopy done for the dysphagia revealed large, deeply cratered esophageal ulcers, a common cause of esophageal dysphagia. Ulcer biopsies were obtained, with routine staining negative for HIV, cytomegalovirus, yeast, or fungal organisms. He was started on acid suppressive therapy, with no improvement in dysphagia. Laboratory test results were significant for subtherapeutic levels of itraconazole therapy and positive urine Histoplasma antigen. These new findings raised concern for histoplasmosis being the cause of the patient's esophageal ulcers. Therefore, the team conducted specialized Grocot-Gomori methenamine silver staining on tissue from the esophageal ulcers, which revealed Histoplasma. For disseminated histoplasmosis treatment, he was admitted for intravenous amphotericin, and his outpatient dose of itraconazole was adjusted. Dysphagia subsequently improved, and follow-up upper endoscopy revealed esophageal ulcers had resolved. CONCLUSIONS This case underscores Histoplasma capsulatum as a rare but significant cause of esophageal ulceration in patients with HIV/AIDS. Proper diagnostic approaches, including specialized staining techniques, are critical when routine examinations fail to identify a pathogen. In patients with HIV/AIDS, clinicians should be keen to consider alternate, less common, causes of esophageal ulcers.
人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）患者可发生食管机会性感染。虽然念珠菌在该人群中常引起感染性食管炎，但其他机会性感染，如巨细胞病毒和单纯疱疹病毒，也可引起食管炎，在某些情况下还可导致食管溃疡。食管较少见的机会性感染包括组织胞浆菌病。
一名有HIV病史的58岁男性因食管吞咽困难入院。他有播散性组织胞浆菌病病史，正在接受伊曲康唑治疗。因吞咽困难进行的上消化道内镜检查显示有大的、深陷的食管溃疡，这是食管吞咽困难的常见原因。获取了溃疡活检组织，常规染色显示HIV、巨细胞病毒、酵母或真菌均为阴性。他开始接受抑酸治疗，但吞咽困难无改善。实验室检查结果显示伊曲康唑治疗水平低于治疗剂量，尿组织胞浆菌抗原呈阳性。这些新发现引发了对组织胞浆菌病是患者食管溃疡病因的担忧。因此，该团队对食管溃疡组织进行了专门的格罗科特-戈莫里六胺银染色，结果显示有组织胞浆菌。对于播散性组织胞浆菌病的治疗，他被收入院接受静脉注射两性霉素治疗，其门诊伊曲康唑剂量也进行了调整。吞咽困难随后有所改善，后续的上消化道内镜检查显示食管溃疡已愈合。
该病例强调荚膜组织胞浆菌是HIV/AIDS患者食管溃疡的一种罕见但重要的病因。当常规检查未能识别病原体时，包括专门染色技术在内的正确诊断方法至关重要。对于HIV/AIDS患者，临床医生应敏锐地考虑食管溃疡的其他少见病因。
