Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2016; 22(15): 4027-4033
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.4027
Intestinal histoplasmosis in immunocompetent adults
Lin-Lin Zhu, Jin Wang, Zi-Jing Wang, Yi-Ping Wang, Jin-Lin Yang
Lin-Lin Zhu, Jin Wang, Zi-Jing Wang, Yi-Ping Wang, Jin-Lin Yang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Zi-Jing Wang, Gastroenterology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
Author contributions: Yang JL and Wang YP designed the research; Zhu LL, Wang J and Wang ZJ performed the research and collected the clinical data; Zhu LL and Wang J analyzed the data; Zhu LL performed the follow-up and wrote the manuscript; all authors have read and approved the final version to be published.
Institutional review board statement: This research was reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University.
Informed consent statement: This is a retrospective study using routinely collected data, results did not have any impact on participants. Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled ”Intestinal histoplasmosis in immunocompetent adults”.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jin-Lin Yang, MD, Department of Gastroenterology, West China hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. mouse-577@163.com
Telephone: +86-28-85423387 Fax: +86-28-85423387
Received: November 8, 2015
Peer-review started: November 8, 2015
First decision: November 27, 2015
Revised: December 13, 2015
Accepted: January 9, 2016
Article in press: January 11, 2016
Published online: April 21, 2016
Abstract

AIM: To present a retrospective analysis of clinical and endoscopic features of 4 cases of immunocompetent hosts with intestinal histoplasmosis (IH).

METHODS: Four immunocompetent adults were diagnosed with IH between October 2005 and March 2015 at West China Hospital of Sichuan University. Clinical and endoscopic characteristics were summarized and analyzed retrospectively. GMS (Gomori methenamine silver), PAS (periodic acid-Schiff) and Giemsa staining technique were used to confirm Histoplasma capsulatum(H. capsulatum). The symptoms, signs, endoscopic presentations, radiographic imaging, pathological stain results and follow-up are presented as tables and illustrations.

RESULTS: The cases were male patients, ranging from 33 to 61 years old, and primarily presented with non-specific symptoms such as irregular fever, weight loss, abdominal pain and distention. Hepatosplenomegaly and lymphadenopathy were the most common signs. Endoscopic manifestations were localized or diffuse congestion, edema, ulcers, and polypoid nodules with central erosion involving the terminal ileum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum, similar to intestinal tuberculosis, tumor, and inflammatory bowel disease. Numerous yeast-like pathogens testing positive for PAS and GMS stains but negative for Giemsa were detected in the cytoplasm of the histiocytes, which were highly suggestive of H. capsulatum.

CONCLUSION: Immunocompetent individuals suffering from histoplasmosis are rarely reported. It is necessary that gastroenterologists and endoscopists consider histoplasmosis as a differential diagnosis, even in immunocompetent patients.

Keywords: Intestinal histoplasmosis, Disseminated histoplasmosis, Immunocompetence, Endoscopic characteristics, Differential diagnosis

Core tip: Intestinal histoplasmosis (IH) is an uncommon disease. It is more likely to be encountered in immunocompromised patients. No case series of IH in immunocompetent patients has been published so far. This retrospective study included 4 cases of immunocompetent adults with intestinal histoplasmosis and focused on presenting the endoscopic characteristics. It is necessary that gastroenterologists and endoscopists consider histoplasmosis as a differential diagnosis, even in immunocompetent patients.