University of Wisconsin–Madison Medical College of Wisconsin

Disseminated Histoplasmosis: An Unusual Cause of Bowel Obstruction

Kent J. Peterson, MD; Michael R. Rose, MD, MPH; Caroline Davitt, MD; Kirk A. Ludwig, MD

WMJ. 2022;121(4):e66-e70

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Introduction: Although histoplasmosis is an extremely rare cause of bowel obstruction, this case describes disseminated gastrointestinal histoplasmosis as it progresses from acute colitis to subacute recurrent bowel obstructions.

Case Presentation: A White man in his early 80s with history of multiple myeloma presented to the emergency department with lightheadedness and diarrhea. Following a diagnostic journey for unspecified colitis, urine antigen testing and endoscopic biopsies led to the diagnosis. During the initial 12 weeks of antifungal treatment, the disease process transitioned from an acute inflammatory syndrome into a recurrent bowel obstruction.

Discussion/Conclusions: Only one other case of histoplasmosis causing recurrent bowel obstruction has been reported; however, that patient succumbed to the disease without surgical intervention. No clear guidelines exist of how to manage bowel obstructions from rare infectious sources, such as histoplasmosis, but close surveillance, multidisciplinary care, and an understanding of gastrointestinal pathology can guide clinicians when encountering atypical etiologies of bowel obstruction.

Author Affiliations: Division of Colon and Rectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin (Peterson, Davitt, Ludwig); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Rose).
Corresponding Author: Kent J. Peterson, MD, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; email; ORCID ID 0000-0001-8093-2040
Funding/Support: None declared.
Financial Disclosures: None declared.
Acknowledgments: The authors thank Patricia Lye, MD; Jacqueline Kuzminski, MD; Jacqueline Gauger; Judy Borchardt; and the Children’s Wisconsin Transport Team for their assistance with this project.
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