Histoplasmosis of The Esophagus

Video Endoscopic Sequence 1 of 13.

Histoplasmosis of The Esophagus

This is a 63 year old woman, who presented with progressive dysphagia of one month the endoscopy shows large ulcers of the middle and lower third of the esophagus as well as signs of candidiasis.

Subsequently was determined that she is suffering from acquired immunodeficiency syndrome (AIDS).

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Endoscopic image of Histoplasmosis of The Esophagus Esophageal involvement with histoplasmosis is uncommon

Video Endoscopic Sequence 2 of 13.

Endoscopic image of Histoplasmosis of The Esophagus
Esophageal involvement with histoplasmosis is uncommon

Such patients usually present with dysphagia secondary to midesophageal compression or stricture. The esophagus can also be involved in cases of disseminated histoplasmosis. Esophageal ulcers or nodular lesions are the usual clinical manifestations in this setting.

Gastrointestinal histoplasmosis (GIH) is an uncommon disease with protean manifestations. It may occur as a result of mediastinal histoplasmosis or in the setting of progressive dissemination. GIH may be misdiagnosed as inflammatory bowel disease, malignancy, or other intestinal diseases leading to inappropriate therapies and unnecessary surgical interventions.

Video Endoscopic Sequence 3 of 13.

Gastroesophageal Junction shows irregular mucosa.

Gastrointestinal histoplasmosis (GIH) is an uncommon disease with protean manifestations. It may occur as a result of mediastinal histoplasmosis or in the setting of progressive dissemination. GIH may be misdiagnosed as inflammatory bowel disease, malignancy, or other intestinal diseases leading to inappropriate therapies and unnecessary surgical interventions.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

Video Endoscopic Sequence 4 of 13.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

This image as well as the video clips displays large ulcers and candidiasis.

Patients with bowel obstruction, perforation, or bleeding, and systemic findings suggestive of histoplasmosis should be evaluated for GIH. This is especially true for immunosuppressed patients, especially those with AIDS.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

Video Endoscopic Sequence 5 of 13.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

Diagnosis first requires consideration of histoplasmosis in the differential in patients with the above types of gastrointestinal abnormalities, and second, familiarity with a battery of mycologic and serologic tests.

Progressive disseminated histoplasmosis (PDH) is lethal if left untreated, and treatment is highly effective.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

Video Endoscopic Sequence 6 of 13.

Endoscopic image and video clip of Histoplasmosis of The Esophagus.

Endoscopic image and video clip of Histoplasmosis of The Esophagus

Video Endoscopic Sequence 7 of 13.

Endoscopic image and video clip of Candidiasis of The Esophagus.

Video Endoscopic Sequence 8 of 13.

Oropharyngeal Candidiasis

Gomori methenamine silver (GMS) stain

Video Endoscopic Sequence 9 of 13.

Gomori methenamine silver (GMS) stain

Because Candida species stain poorly by hematoxylin and eosin, staining with periodic acid-Schiff (PAS), Gridley stain, or Gomori methenamine silver (GMS) stain is used. In both Gridley stain and the PAS procedure, fungi appear pinkish red. GMS technique stains yeast cell walls brown-black as a result of deposition of reduced silver.

Presence of blastospores and characteristic pseudohyphae or hyphae in the superficial epithelial tissues identifies the fungus as a species of Candida. GMS staining alone cannot perform the speciation of the organism; therefore, cultural or nucleic acid studies also should be used. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) are available.

Blastospores similar to those in Candida species may be seen in histoplasmosis or cryptococcosis, both of which are increasingly prevalent and may manifest orally with increasing frequency in the AIDS epidemic. If only blastospores of candidal organisms are seen in tissue sections of patients in whom infection is suspected, serial sections should be searched carefully for pseudohyphae or hyphae

Video Endoscopic Sequence 10 of 13.

Blastospores similar to those in Candida species may be seen in histoplasmosis or cryptococcosis, both of which are increasingly prevalent and may manifest orally with increasing frequency in the AIDS epidemic. If only blastospores of candidal organisms are seen in tissue sections of patients in whom infection is suspected, serial sections should be searched carefully for pseudohyphae or hyphae.

Gomori methenamine silver (GMS) stain shows Histoplasma Capsulatum

Video Endoscopic Sequence 11 of 13.

Gomori methenamine silver (GMS) stain shows Histoplasma Capsulatum

Hematoxilina Eosina Stain Histoplasma Capsulatum

Video Endoscopic Sequence 12 of 13.

Hematoxilina Eosina Stain Histoplasma Capsulatum

A PAS stain highlights Histoplasma Capsulatum

Video Endoscopic Sequence 13 of 13.

A PAS stain highlights Histoplasma Capsulatum

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