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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*

Infectious Diseases in Clinical Practice: November 2013 - Volume 21 - Issue 6 - p 383–385
doi: 10.1097/IPC.0b013e31827cad72
Case Report

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.

From the *Division of Infectious Diseases, Department of Internal Medicine and †Department of Pathology, University of Nebraska Medical Center, Omaha NE.

Correspondence to: Uriel Sandkovsky, MD, Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, 988106 Nebraska Medical Center, Omaha, NE. 68198-8106. E-mail:

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

© 2013 by Lippincott Williams & Wilkins.