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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31827cad72
Case Report

Disseminated Histoplasmosis Presenting as Esophageal Ulceration in an HIV-Infected Man

Sandkovsky, Uriel MD*; Ali, Karim F. MD*; VanSchooneveld, Trevor C. MD*; Radio, Stanley J. MD; Swindells, Susan MBBS*

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Abstract: A 30-year-old man with advanced human immunodeficiency virus–infection presented with worsening dysphagia and odynophagia of 4 months’ duration. He had been on a revised combination antiretroviral regimen for 3 months with a recent CD4 count of 57 cells/mm3 and human immunodeficiency virus viral load of less than 50 copies/mL. Esophagogastroduodenoscopy showed erosive esophagitis and esophageal ulcers. Histopathologic examination was negative for herpes viruses and cytomegalovirus but showed intracellular yeast consistent with histoplasmosis. Histoplasma antigenuria was more than 39 ng/mL, which confirmed the diagnosis of disseminated histoplasmosis. After 3 weeks of treatment with liposomal amphotericin B and significant improvement, antifungal therapy was changed to itraconazole suspension. Histoplasma capsulatum is well known to cause gastrointestinal involvement in patients with acquired immunodeficiency syndrome, but esophageal involvement is rare.

© 2013 by Lippincott Williams & Wilkins.

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