An Unexpected Culprit: Fatal Gastrointestinal Hemorrhage due to Duodenal Histoplasmosis in a Patient With End-Stage Renal Disease.

Abstract

Histoplasmosis has a wide spectrum of presentations ranging from mild pulmonary disease to a more widespread infection leading to disseminated histoplasmosis. Gastrointestinal histoplasmosis is a rare form of disseminated histoplasmosis that most commonly causes nonspecific symptoms and rarely presents with serious symptoms. Duodenal involvement is further rare but can cause ulcerated lesions leading to upper gastrointestinal bleed. The potential for a nonspecific initial presentation quickly progressing to a fatal upper gastrointestinal bleed makes it important to keep Gastrointestinal histoplasmosis in our list of differentials, as timely initiation of appropriate antifungal therapy can significantly reduce the risk of severe complications and mortality.