Reply to Mavrogenis et al.

We thank Mavrogenis et al. for their interest in our case report.

Histoplasmosis is an unusual fungal infection, most commonly occurring in cave explorers. Nonetheless it can affect immunosuppressed patients and the medical team must think of disseminated histoplasmosis when encountering multiple ulcers in the digestive tract of such patients.

As previously published [1], the colon is the main site of lesions and can be affected in up to 59 % of patients. The Mavrogenis case differs from ours in the fact that their patient had colonic lesions and the upper gastrointestinal tract was not affected. In our case, there were gastric, duodenal, and colonic lesions, which was an unusual presentation that had never previously been described. Histopathology is mandatory in order to make the diagnosis, and itraconazole is the treatment of choice, as shown by our group [2] and Mavrogenis et al.

References

• 1 Kauffman C A. Histoplasmosis: a clinical and laboratory update.  Clin Microbiol Rev. 2007;  20 115-132
• 2 Colaiacovo R, de Castro A CF, Shiang C et al. Disseminated histoplasmosis: a rare cause of multiple ulcers in the gastrointestinal tract.  Endoscopy. 2011;  43 E216