Histoplasmosis intestinal como causa de diarrea crónica en un paciente infectado virus de inmunodeficiencia humana

Abstract

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, currently considered opportunistic in patients infected by the Human Immunodeficiency Virus. It reaches a mortality rate between 19 and 39%, mainly in its disseminated clinical presentation. More than 90% of the cases that have been reported of Intestinal Histoplasmosis occur in patients infected with HIV. Worldwide there are few studies and reports of cases of intestinal histoplasmosis, this may present as a single isolated manifestation. The clinical manifestations are characterized by abdominal pain, fever, weight loss, and diarrhea. We describe the case of a 34-year-old male patient, with risk factors, living in a rural area, tropical climate, cleaning the poultry house, with a diagnosis of infection by the Human Immunodeficiency Virus for 4 years in treatment with antiretrovirals, poor adherence to treatment and CD4 count less than 50 cells, comes to emergency at José Maria Velasco Ibarra Hospital in Tena for presenting intermittent chronic diarrhea. It is decided to enter and perform complementary studies, it is decided to perform colonoscopy where the lesion is found in the descending colon compatible with depressed lesion excavated type 0-III (PARIS), and it is decided to take tissue for a biopsy which reports the presence of compatible spores with Histoplasma capsulatum. Treatment was started with amphotericin B for 2 weeks and then a scheme with itraconazole was applied, which is maintained until treatment is completed according to the established recommendations. Patient in follow-up, control, and treatment of the underlying disease.