[Digestive disorders in histoplasmosis. Report of a case of ulcerous enterocolitis caused by Histoplasma capsulatum (author's transl)].

Report of a new American histoplasmosis caused by Histoplasma capsulatum in a young adult Haitian, and review of the digestive disorders as reported in the previous medical papers. In the present case, the first localization detected was a granulomatous hepatitis which lead to the disclosure of an ulcerous entercolitis. Tuberculosis and Crohn disease were first suspected, but their treatment induced a worse turn of the patient's condition and compelled to a laparotomy, which shown ulcerous entercolitis with associated lymph-nodes. Per operative pathological examination gave evidence of Histoplasma capsulatum yeasts. Treatment, first with miconazole and later on with amphotericin B could not prevent the death of the patient affected by a deficiency of cell mediated immunity. Disseminated histoplasmosis is rare: 1 out of 5,000 cases of American histoplasmosis-digestive disorders are generally detected by surgery or post-mortem examination. They occur in 20 p. 100 of the cases envolving the whole digestive tract from mouth to anus, giving mucous ulcerations, difficult to detect by X ray. Endoscopic control with biopsies has therefore a great value. In Histoplasma duboisii, histoplasmosis digestive disorders are very unusual and localized to intestine. They may be detected by surgery, or by endoscopies. In the reported case, in spite of the geographical origin of the patient, the diagnosis of American histoplasmosis was not retained because of the negativity of the immunological tests and of the biopsies performed before surgery. An afterward checking of these biopsy specimens gave evidence of a few yeasts. Special dyeing technique may have made the diagnosis somewhat earlier; this is important because new non toxic imidazole drugs seem to be active against these yeasts.