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An Unusual Cause of Dysphagia in a Patient With Acquired Immunodeficiency Syndrome (AIDS)

Jiménez-Encarnación, Esther MD*; Velez-Rosario, Roman MD; Agosto-Arroyo, Emmanuel MD; Marrero-Martinez, Sylmarie MD; Colón-Acevedo, Betsy MD; Colón-Pérez, Miguel A. MD, FACP§; Saavedra-Sanquirico, Sonia MD, PhD*

Infectious Diseases in Clinical Practice: January 2012 - Volume 20 - Issue 1 - p 91–94
doi: 10.1097/IPC.0b013e31822949aa
Case Reports

Abstract: Disseminated histoplasmosis (DH) is an acquired immunodeficiency syndrome–defining condition, yet, esophageal involvement is an uncommon presentation of histoplasmosis but has been recognized in 2 clinical settings: as a result of contiguous histoplasmosis with mediastinal lymphadenopathy secondary to midesophageal compression, and in cases of disseminated histoplasmosis where esophageal lesions are the usual clinical manifestation. We report a case of a 32-year-old male patient with disseminated histoplasmosis presenting with esophageal narrowing that was initially misdiagnosed as esophageal candidiasis. The final diagnosis was established with a fine needle aspiration of an enlarged cervical lymph node, which showed fungal structures within macrophages consistent with histoplasmosis. Fungal stains were also positive, supporting the diagnosis. The patient was then successfully treated with antifungal therapy. Disseminated histoplasmosis should always be considered in the differential diagnosis of dysphagia in immunocompromised patients, although a more common entity such as candidiasis might be present. Failure to do so may be fatal.

From the *Department of Internal Medicine, VA Caribbean Healthcare System; †Department of Pathology and Laboratory Medicine, University of Puerto Rico School of Medicine; Departments of ‡Internal Medicine, and §Infectious Disease, San Juan City Hospital, San Juan, PR.

Correspondence to: Esther Jiménez-Encarnación, MD, Division of Rheumatology University of Puerto Rico School of Medicine, San Juan, PR 00936-506. E-mail: esthe.jimenez@upr.edu; wila226@hotmail.com.

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.