SHM Converge Scientific Abstract ePoster Gallery-The Importance of Diagnosing Histoplasmosis in Inflammatory Bowel Disease

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This case highlights the importance of recognizing disseminated histoplasmosis in patients with inflammatory bowel disease, especially those receiving TNF-alpha inhibitor therapy such as infliximab. Histoplasmosis is the most common endemic fungal infection in the United States and is a known complication of immunosuppression.<br /><br />A 49-year-old man with ulcerative colitis and rheumatoid arthritis presented with fever, night sweats, myalgias, and diffuse abdominal pain after a recent infliximab infusion and a course of antibiotics and prednisone. Because his symptoms resembled a flare of ulcerative colitis, imaging and sigmoidoscopy were performed. CT showed hepatosplenomegaly, splenic lesions, lymphadenopathy, and pulmonary nodules, while endoscopy demonstrated chronic active colitis with ulcerations. Persistent fevers led to infectious disease consultation, and histoplasmosis was strongly suspected due to his immunocompromised state.<br /><br />Itraconazole was started and infliximab was stopped, leading to clinical improvement. Subsequent testing confirmed disseminated histoplasmosis.<br /><br />The case underscores that disseminated histoplasmosis can closely mimic an inflammatory bowel disease flare, and steroids are often given empirically, which may worsen invasive fungal infection. Diagnosis relies on clinical suspicion supported by antigen testing, blood cultures, cytology, and tissue biopsy or body fluid histopathology. Treatment depends on severity and may include itraconazole or amphotericin B, along with stopping TNF-alpha inhibitors for several months. Restarting immunosuppressive therapy should be carefully coordinated, with close follow-up and consideration of long-term antifungal maintenance in some patients.

Asset Subtitle

Kavya Yellamraju

Meta Tag

Author List Jay Anderson, Kavya Yellamraju

Category Clinical Vignettes

Concept Histoplasmosis

Concept TNF-alpha Inhibitor

Concept Antifungal Therapy

Concept Inflammatory Bowel Disease

Concept Rapid Antigen Test

Distinguished Non-Finalist

Presenter Organization Ohio Health Riverside Methodist Hospital

Presenting Author Kavya Yellamraju

Track Adult

Keywords

disseminated histoplasmosis

inflammatory bowel disease

TNF-alpha inhibitor

infliximab

ulcerative colitis

immunosuppression

fungal infection

hepatosplenomegaly

itraconazole

antigen testing

Histoplasmosis

TNF-alpha Inhibitor

Antifungal Therapy

Inflammatory Bowel Disease

Rapid Antigen Test