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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.

Copyright © 2012 by Lippincott Williams & Wilkins

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