Diagnosis by molecular pathology of an early and atypical histoplasmosis lesion in the duodenum of an immunocompromised patient: A case report

Sumiyoshi,Sayoko; Tanaka,Shinichi; Kato,Hirotomo; Takagi,Kohji; Minamisaka,Takashi; Noguchi,Akira; Nakajima,Takahiko; Imura,Johji

doi:10.3892/br.2020.1382

Diagnosis by molecular pathology of an early and atypical histoplasmosis lesion in the duodenum of an immunocompromised patient: A case report

Authors:
- Sayoko Sumiyoshi
- Shinichi Tanaka
- Hirotomo Kato
- Kohji Takagi
- Takashi Minamisaka
- Akira Noguchi
- Takahiko Nakajima
- Johji Imura
View Affiliations

Affiliations: Medical Department, Faculty of Medicine, University of Toyama, Toyama 930‑0194, Japan, Department of Diagnostic Pathology, Field of Medical, Academic Assembly, University of Toyama, Toyama 930‑0194, Japan, Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Shimotsuke, Tochigi 329‑0498, Japan
Published online on: October 30, 2020 https://doi.org/10.3892/br.2020.1382
Article Number: 6
Copyright: © Sumiyoshi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum (HC), which can occasionally be aggressive resulting in the formation of granulomatous lesions. These are usually located in the lungs; however, immunocompromised patients may occasionally develop disseminated lesions in other organs as well. Human immunodeficiency virus (HIV) primarily infects cells of the immune system expressing CD4 molecules. Not only does HIV multiply within these cells, but it can also kill them or otherwise cause loss of cellular function, leading to an immunocompromised state. As a result, in an immunocompromised patient, infection with HC can have serious implications, often the development of visceral histoplasmosis in different organs. Although several types of lesions are formed in HC‑infected organs, it may be difficult to distinguish the causative organism from other pathogens based on morphology alone. The present case report describes the case of a 57‑year‑old woman, from South America, who may have been infected with HC >20 years previously, remaining asymptomatic over the years. She later developed a lesion in the duodenum associated with immunodeficiency caused by HIV infection. The differential diagnosis of this case was made on the basis of several specific morphological findings using histopathological analysis and molecular pathological techniques. The pathogenesis of characteristic lesions caused by HC in the presence of HIV infection was also reviewed.

View Figures

View References

1	Köhler JR, Hube B, Puccia R, Casadevall A and Perfect JR: Fungi that infect humans. Microbiol Spectr. 5:FUNK-0014–2016. 2017.PubMed/NCBI View Article : Google Scholar
2	Diaz JH: Environmental and wilderness-related risk factors for Histoplasmosis: More than bates in caves. Wilderness Environ Med. 29:531–540. 2018.PubMed/NCBI View Article : Google Scholar
3	Bahr NC, Antinori S, Wheat LJ and Sarosi GA: Histoplasmosis infections worldwide: Thinking outside of the Ohio River valley. Curr Trop Med Rep. 2:70–80. 2015.PubMed/NCBI View Article : Google Scholar
4	Deepe GS: Histoplasma capsulatum (Histoplasmosis). In: Mandell, Douglas, and Bennett's Principles and Practice of infectious diseases. Bennett JE, Dolin R and Blaser MJ (eds). 8th edition. Elsevier Saunders, Philadelphia, PA, pp2949-2962, 2014.
5	Hatakeyama S, Okamoto K, Ogura K, Sugita C and Nagi M: Histoplasmosis among HIV-infected patients in Japan: A case report and literature review. Jpn J Infect Dis. 72:330–333. 2019.PubMed/NCBI View Article : Google Scholar
6	Kauffman CA: Histoplasmosis: A clinical and laboratory update. Clin Microbiol Rev. 20:115–132. 2007.PubMed/NCBI View Article : Google Scholar
7	Mukhopadhyay S and Doxtader EE: Visibility of Histoplasma within histiocytes on hematoxylin and eosin distinguishes disseminated histoplasmosis from other forms of pulmonary histoplasmosis. Hum Pathol. 44:2346–2352. 2013.PubMed/NCBI View Article : Google Scholar
8	Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Roldan EQ, Izzo I, Pinsi G, Lorenzin G, Facchetti F, et al: Disseminated histoplasmosis as AIDS-presentation. Case report and comprehensive review of current literature. Mediterr J Hematol Infect Dis. 10(e2018040)2018.PubMed/NCBI View Article : Google Scholar
9	Sharma R, Lipi L, Gajendra S, Mohapatra I, Goel RK, Duggal R, Mishra SR and Gautam D: Gastrointestinal histoplasmosis: A case series. Int J Surg Pathol. 25:592–598. 2017.PubMed/NCBI View Article : Google Scholar
10	Psarros G and Kauffman CA: Colonic histoplasmosis: A difficult diagnostic problem. Gastroenterol Hepatol (NY). 3:461–463. 2007.PubMed/NCBI
11	Azar MM, Loyd JL, Relich RF, Wheat LJ and Hage CA: Current concepts in the epidemiology, diagnosis, and management of histoplasmosis syndromes. Semin Respir Crit Care Med. 41:13–30. 2020.PubMed/NCBI View Article : Google Scholar
12	Ohno H, Tanabe K, Umeyama T, Kaneko Y, Yamagoe S and Miyazaki Y: Application of nested PCR for diagnosis of histoplasmosis. J Infect Chemother. 19:999–1003. 2013.PubMed/NCBI View Article : Google Scholar
13	Watanabe M, Hotchi M and Nagasaki M: An autopsy case of disseminated histoplasmosis probably due to infection from a renal allograft. Acta Pathol Jpn. 38:769–780. 1988.PubMed/NCBI View Article : Google Scholar
14	Walsh TJ, Larone DH, Schell WA and Mitchell TG: Histoplasma, blastomyces, coccidioides and other dimorphic fungi causing systemic mycoses. In: Manual of Clinical Microbiology. Murray PR, Baron EJ, Jorgensen JH, Pfaller MA and Yolken RH (eds). Vol 2. 8th edition. ASM Press, Washington, DC, pp1781-1797, 2003.
15	Wojewoda C and Procop GW: Infections with Yeast and Yeastlike Fungi. In: Pathology of Infectious Diseases. Procop GW and Pritt BS (eds). Elsevier, Philadelphia, PA, pp531-572, 2014.
16	Schmitt BH and Pritt BS: Dematiaceous fungal infections. In: Pathology of Infectious Diseases. Procop GW and Pritt BS (eds). Elsevier, Philadelphia, PA, pp516-530, 2014.
17	Headley SA, Pretto-Giordano LG, Di Santis GW, Gomes LA, Macagnan R, da Nobrega DF, Leite KM, de Alcantara BK, Itano EN, Alfieri AA, et al: Paracoccidioides brasiliensis-associated dermatitis and lymphadenitis in a dog. Mycopathologia. 182:425–434. 2017.PubMed/NCBI View Article : Google Scholar
18	Zhang YQ, Xu XG, Zhang M, Jiang P, Zhou XY, Li ZZ and Zhang MF: Sporotrichosis: Clinical and histopathological manifestations. Am J Dermatopathol. 33:296–302. 2011.PubMed/NCBI View Article : Google Scholar
19	Adenis AA, Aznar C and Couppie P: Histoplasmosis in HIV-infected patients: a review of new developments and remaining gaps. Curr Trop Med Rep. 1:119–128. 2014.PubMed/NCBI View Article : Google Scholar
20	Abbas AK, Lichtman AH and Pillai S: Congenital and acquired immunodeficiencies. In: Cellular and Molecular Immunology. Abbas AK, Lichtman AH and Pillai S (eds). 9th edition. Elsevier, Philadelphia, PA, pp459-487, 2017.
21	Abbas AK, Lichtman AH and Pillai S: Immunity to microbes. In: Cellular and Molecular Immunology. Abbas AK, Lichtman AH and Pillai S (eds). 9th edition. Elsevier, Philadelphia, PA, pp351-372, 2017.
22	Kumar V, Abbas AK and Aster JC: Diseases of the immune system. In: Robbins Basic Pathology. Kumar V, Abbas AK and Aster JC (eds). 10th edition. Elsevier, Philadelphia, pp121-188, 2017.
23	North RJ and Jung YJ: Immunity to tuberculosis. Annu Rev Immunol. 22:599–623. 2004.PubMed/NCBI View Article : Google Scholar
24	Khader SA and Cooper AM: IL-23 and IL-17 in tuberculosis. Cytokine. 41:79–83. 2008.PubMed/NCBI View Article : Google Scholar