SMALL BOWEL PERFORATION DUE TO DISSEMINATED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

Objectives: Histoplasmosis is the most prevalent endemic mycosis in the US with a wide range of reported clinical manifestations, with GI manifestations being relatively uncommon. While disseminated infection that leads to more severe disease typically affects immunocompromised patients, we report the case of a 54-year-old immunocompetent female who presented with abdominal pain and septic shock due to a distal ileal perforation found to be secondary to histoplasmosis. Patient was taken urgently to the OR and underwent exploratory laparotomy with resection of the perforated ileal segment and ileoileal anastomosis. Histopathology indicated that the area of perforation was associated with intense histoplasmosis infection with transmural inflammation. With post-op supportive care including a course of amphotericin B, the patient clinically improved and was ultimately discharged home on POD 34. The following case report includes a brief review of disseminated histoplasmosis GI manifestations, diagnosis, and management as well as raises the importance of keeping disseminated fungal infection in the differential for patients being treated for gastrointestinal perforation, even those who are immunocompetent.

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