19 May 2025
: Case report 
A Diagnostic Dilemma: Disseminated Histoplasmosis Presenting as a Small-Bowel Obstruction
Unusual clinical course, Challenging differential diagnosis
Nicolas Tapia Stoll
EF 1, Hasan Saleh E 2, Brittany Jackson E 2*, Aleksandra Murawska Baptista EF 2, Jana G. Al Hashash DEF 3, Justin Oring EF 4, Ravi Durvasula EF 4, Raouf Nakhleh C 5, Jami Kinnucan EF 3, Daniel Kashani AEF 2
DOI: 10.12659/AJCR.946515
Am J Case Rep 2025; 26:e946515
Table 2 Comparison of patients described in referenced case reports.
| Case report | Age, Sex | Immunocompromised | Initial presentation | Observed system involvements | Differential siagnosis | Diagnostic approach | Treatment |
|---|---|---|---|---|---|---|---|
| Ahmed et al []4 | 38, F | Yes – immunosuppressants for suspected Crohn’s disease | Abdominal pain, bloody diarrhea, septic shock | Crohn’s disease | Positive pathology samples, positive serum and urine antigen tests | IV liposomal amphotericin B and then itraconazole | |
| Rowe et al []5 | 73, F | Yes – immunosuppressants (Infliximab and methotrexate) for rheumatoid arthritis | Abdominal pain, diarrhea, weight loss | N/A | Positive pathology samples, negative serum and urine antigen | Itraconazole | |
| Hjermstad et al []10 | 50, F | Yes – immunosuppressants (adalimumab) for rheumatoid arthritis | Right upper quadrant pain, jaundice, fever, dyspnea | Choledocholithiasis with potential SARS-CoV2 infection, Mirizzi syndrome | Positive pathology and urine antigen tests | Itraconazole | |
| Abu et al []11 | 20, F | Yes –HIV | Epigastric pain, nausea, vomiting, fever | N/A | Positive Pathology | IV liposomal amphotericin B and then itraconazole | |
| Aggarwal et al []12 | 37, F | No | Incidentally noticed conjunctival icterus and abnormal LFT’s | Mucinous cystadeno-carcinoma | Positive Pathology and Serology | Voriconazole (after failure to tolerate itraconazole) | |
| Asif et al []13 | 41, F | Yes – chronic steroid use for history of interstitial cystitis | Abdominal pain in epigastric region, hypercalcemia, anemia, leukocytosis, and elevated inflammatory markers, lipase, creatinine | Acute necrotizing pancreatitis with superimposed infection | Post-mortem autopsy pathology | N/A | |
| Kamili et al []14 | 40, F | Yes – immunosuppressants (Infliximab) for psoriatic arthritis | Fever, dry cough, arthralgia, weight loss, polyurea, polydipsia, hypercalcemia | N/A | Positive pathology and fungal immunoassays with culture | Amphotericin B and then itraconazole | |
| Hertan et al []19 | 37, M | Yes – HIV | Abdominal pain, diarrhea, weight loss, cachexia. | N/A | Positive Pathology | Amphotericin B and then itraconazole, but still died | |
| Nehme et al []20 | 32, M | Yes – History of X-linked hyper-IgM syndrome. due to CD40 ligand deficiency | Fevers, night sweats, weight loss, abdominal pain, nausea. | N/A | Positive pathology, positive urine antigen test | Amphotericin B and then itraconazole | |
| Lee et al []21 | 43, M | Yes – HIV complicated by cytomegalovirus (untreated) | Weight loss, abdominal pain, odynophagia, bloody diarrhea | Crohn’s disease | Positive pathology, PCR with BAL, and urine antigen test | IV liposomal amphotericin B and then voriconazole | |
| Srinivasan et al []24 | <1, M | No | Increased work of breathing, tachypnea, expiratory wheezing | Neurogenic tumors, lymphoma, teratoma, germ cell tumors, tuberculosis | Positive serology, negative pathology stains, serum and urine antigen tests. Urine and serum antigen tests were positive after ultrafiltration and EDTA + heat denaturation. | Itraconazole (10 weeks) and Prednisone (2 weeks) |