Case-Report | DOI: https://doi.org/10.31579/2692-9392/012
*Corresponding Author: Sudha Kodali, Sherrie and Alan Conover Center for Liver Disease, Houston Methodist Hospital, Houston, Texas
Citation: Abughazaleh S., Daniel S. Zhang., Massey D., Mary R. Schwartz., David W. Victor., Kodali S., (2020) Fungki Ulcers. J. Archives of Medical Case Reports and Case Study. 3(1); DOI:10.31579/2692-9392/012
Copyright: © 2020 Sudha Kodali, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 June 2020 | Accepted: 17 June 2020 | Published: 25 June 2020
Keywords: fungki ulcers; idiopathic pulmonary fibrosis
A 61-year-old female with a history of bilateral lung transplantation for idiopathic pulmonary fibrosis presented with shortness of breath, cough and diarrhea. She was on chronic immunosuppressive medications, including Tacrolimus and mycophenolate, and on apixaban for deep vein thrombosis.
A 61-year-old female with a history of bilateral lung transplantation for idiopathic pulmonary fibrosis presented with shortness of breath, cough and diarrhea. She was on chronic immunosuppressive medications, including Tacrolimus and mycophenolate, and on apixaban for deep vein thrombosis.
On admission, she was found have iron deficiency anemia. Her previous work-up for mild iron deficiency anemia five years earlier included an EGD and colonoscopy which were both negative. Upper endoscopy at this time showed a gastric antral polyp. Colonoscopy revealed multiple ulcers in the ileocecal valve, cecum, hepatic flexure, transverse colon, and descending colon (Figure 1) and (Figure 2). Colon biopsies obtained at multiple sites showed numerous budding yeast with morphologic features of Histoplasma capsulatum (Figures 3 and 4). The patient subsequently underwent bronchoscopy with cultures which confirmed disseminated Histoplasmosis. She was treated with IV amphotericin B with significant improvement in her symptoms and will be continued on lifelong itraconazole.
This case highlights a unique presentation of a lung transplant patient who was found to have disseminated Histoplasmosis initially diagnosed with endoscopy. Although rates of disseminated Histoplasmosis are increased in immunocompromised patients compared to their immunocompetent counterparts, this remains low in solid organ transplant patients with an estimated incidence of 1 case per 1000 person-years (1). A multi-center series of solid organ transplant patients with disseminated Histoplasmosis found that only 5% of the patients were lung transplant recipients. This series also found that only 19% of solid organ transplant patients diagnosed with disseminated histoplasmosis had GI involvement (2). The vast majority of patients with disseminated Histoplasmosis present with predominantly pulmonary complaints, with only 3-12% presenting with primarily GI complaints (3). This case illustrates that while disseminated Histoplasmosis in a lung transplant patient is uncommon, and presentation with GI symptoms even more uncommon, it may occur. Endoscopy may provide the diagnosis in this setting, enabling appropriate
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