Schwere Kolitis durch Histoplasma capsulatum bei einer Patientin mit Aids

Zusammenfassung

Eine 32 Jahre alte HIV-positive Patientin aus Ghana wurde mit einem septischen Krankheitsbild, Diarrhö, Anämie und erheblichem Gewichtsverlust stationär aufgenommen. Initial konnten eine Mycobacterium-tuberculosis- und eine Salmonella-typhi-Infektion diagnostiziert werden. Entsprechende Therapien führten zu einer deutlichen Verbesserung der klinischen Symptomatik. Nach fünf Wochen jedoch kam es zu einem Wiederauftreten von Fieber und Diarrhöen. In Blutkulturen und in histologischen Untersuchungen von koloskopisch gewonnenen Biopsien konnte Histoplasma capsulatum nachgewiesen werden. Die Patientin erholte sich vollständig nach spezifischer antimykotischer Therapie mit Amphotericin B und Itraconazol. Dieser Fallbericht veranschaulicht, dass medizinisches Personal beim Umgang mit immunsupprimierten Patienten aus Endemiegebieten mit den Symptomen sowie den diagnostischen und therapeutischen Maßnahmen dieser seltenen Pilzerkrankung vertraut sein sollte.

Abstract

The case of a thirty-two-year-old female HIV-positive patient from Ghana admitted with a septic illness, diarrhoea, anaemia, and severe weight loss is presented. During an extensive diagnostic work-up Mycobacterium tuberculosis infection and typhoid fever were detected. Specific treatment led to marked improvement in the patient’s condition. However, five weeks later high fever and diarrhoea recurred. Histological examination of biopsies from coloscopy and blood cultures revealed Histoplasma capsulatum. The patient recovered completely following antifungal therapy with amphotericin B and itraconazole. The case presented emphasises the need for medical staff dealing with immunocompromised patients from endemic areas to be aware of symptoms, diagnostic features, and therapeutic measures of this rare fungal infection.

Schlüsselwörter

Histoplasmose - Histoplasma capsulatum - Kolitis - Tuberkulose - Typhus - HIV - Aids

Key words

Histoplasmosis - Histoplasma capsulatum - colitis - tuberculosis - typhoid fever - HIV - Aids

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