Intestinal histoplasmosis in immunocompetent adults

Table 1 Baseline characteristics of 4 patients

	Case A	Case B	Case C	Case D
Age (yr)	61	33	59	28
Sex	Male	Male	Male	Male
Underlying diseases	Arthritis1	No	AP, HBV2	Onychomycosis3
Risk factor
HIV	Negative	Negative	Negative	Negative
Injection drug use	Deny	Deny	Deny	Deny
Glucocorticoids	Not used	Not used	Not used	Not used
Other-immunosuppressive agents	Not used	Not used	Not used	Not used
CD4 counts (/mm3)
Before treatment	Not reported	159	145	86
After treatment	Not reported	221	229	Not reported

¹Arthritis of the left shoulder with amyotrophy;

²Acute pancreatitis 30 years previously, healed; hepatic B virus (HBV) infection 9 years previously, but HBsAg (-), anti-HBs(-), HBeAg (-), anti-HBe (+), anti-HBc (+) on admission;

³Onychomycosis in multiple fingernails. HIV: Human immunodeficiency virus; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis E antigen.

Table 2 Symptoms, signs and sites of involvement

	Case A	Case B	Case C	Case D
Symptoms
Fever	No	Yes	Yes	Yes
Temperature (°C)		35.3-40.3	35.8-38.7	35-40.3
Night sweat	No	Yes	Yes	Not reported
Chills	No	No	No	Yes
Antibiotic1	Moxifloxacin2	Levofloxacin3	Anqi4	Penicillin5, Amikacin5
	Metronidazole2			Azithromycin5
				Levofloxacin6
				Ceftriaxone5, Xianshu7
Abdominal pain	Right abdomen	No	Yes	Whole abdomen
Abdominal distention	Yes	No	Yes	Upper abdomen
Diarrhea	No	No	No	Yes8
Anorexia	Yes	Yes	Yes	Not reported
Pharyngalgia	No	Yes	No	Not reported
Cough	No	Yes	No	No
Expectoration	No	Yes	No	No
Weight loss	Not apparent	15 kg	4 kg	10 kg
Signs
Lymphadenectasis	No	Yes9	No	Yes
Abdominal tension	No	No	No	Yes
Hepatomegaly	No	Not palpable	Yes10	Yes
Splenomegaly	No	Yes11	Yes12	Yes
(Rebound) tenderness	No	No	No	Yes
Shifting dullness	Negative	Negative	Negative	Positive
Involvement
Bone marrow		√	√	√
Pulmonary
Colon	√	√	√	√
Terminal ileum		√	√	√

¹Empirically used, but invalid;

²For 5 d, dosage unknown;

³0.4 g iv daily for 26 d;

⁴Amoxicillin and potassium clavulanate tablets 0.3125 g tid po for 1 wk;

⁵Dosage unknown;

⁶0.4 g iv daily for 28 d in our hospital; dosage unknown in other hospital;

⁷Cefoperazone sulbactam sodium 2.0 g iv bid for 8 d then 2.0 g iv tid for 7 d;

⁸Black watery stool with amount unknown, 7-10 times per day;

⁹1 × 1 cm soft lymphatic node without adhesion in the left armpit;

¹⁰3 cm below the right rib border and 5 cm below the xiphoid;

¹¹5 cm below the left rib border;

¹²3 cm below the left rib border.

Table 3 Endoscopic findings

	Case A (cm)	Case B (cm)	Case C (cm)	Case D (cm)
Lesions
Protrusions with erosion	√
Flat polypoid uplift				√
Nodular deposits		√	√
Edematous mucosa		√	√	√
Multiple ulcers		√	√
Stricture		√
Location and size
Ascending colon	2.0	0.5-1.01	0.3 × 0.3	0.5
Transverse colon		0.5-1.01	1 × 0.8	0.3-0.6
Descending colon		0.5-1.01		0.3-0.6
Sigmoid colon		0.5-1.01		0.3-0.6
Terminal ileum			1.5 × 1.0	0.5
Rectum		0.5-1.01		0.3-0.6
Biopsy texture	Soft	Fragile	Soft	Soft
		hemorrhage

¹Lesion distribution in all segments from rectum to descending colon until the colonoscope could not continue.

Table 4 Radiographic findings

	Case A	Case B	Case C	Case D
Abdominal
Lesions	Bowel-wall thickening	Hepatosplenomegaly	Hepatic cyst	Hepatosplenomegaly
				Splenic infarction
				Lymphadenopathy
	Ascending colon			Ascites
Location	Ileocecal			Intraperitoneal
				Retroperitoneal
Chest
Lesions	Small nodular	Nodular shadows1	Pleural-effusion	Pleural-effusion
	right middle lobe		Atelectasis
Location	left inferior lobe	right lower lobe	right lower lobe

¹1.7 cm nodular shadow in the dorsal segment of the right lower lobe, with shrinkage after treatment.