Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review.

Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

[Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases]. / Paracoccidioidomicosis colónica en un hospital de Lima - Perú: reporte de 4 casos.

Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient.

Paracoccidioidomicosis colónica en un hospital de Lima - Perú: reporte de 4 casos / Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases

La paracoccidioidomicosis es la micosis más prevalente de Sudamérica. En nuestro medio la afectación mucocutánea y linfática suele ser la de mayor prevalencia, siendo el compromiso intestinal pocas veces reportado. Se reportan 4 casos de afectación colónica con manifestación de dolor abdominal, diarrea crónica y disminución de peso en los cuales el diagnóstico se realizó a través de la anatomía patológica con la tinción de Gomori. La edad promedio fue de 29 años. La colonoscopía reveló presencia de múltiples úlceras en colon y en íleon distal. Como comorbilidad se encontró VIH en un paciente

Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient

Histoplasmosis del colon y recto en un paciente de Perú / Colon and rectum histoplasmosis in a patient from Peru

Se reportó un caso de varón de 52 años con historia de 3 meses caracterizada por pujo, tenesmo, hematoquezia, dolor al defecar, disminución de 18 kg de peso, fiebre, secreción fecaloidea y purulenta a través de orificio perianal. A la colonoscopía se evidencian múltiples úlceras en colon ascendente, transverso y descendente. También en recto se aprecia lesión elevada de aproximadamente 5 cm. Las biopsias de dichas lesiones fueron coloreadas con hematoxilina-eosina y tinción de Gomori-Grocott demostrando múltiples macrógafos conteniendo microorganismos compatibles con histoplasmosis. Las pruebas para ELISA VIH, HTLV I-II fueron negativas. La histoplasmosis del colon y recto en paciente inmunocompetente es extremadamente rara, habiéndose reportado pocos casos.

We report a case of a male patient of 52 years old with a 3 months history of pushing, tenesmus, hematochezia, pain while defecating, lost of 18 kg of weight, fever, fecaloid and purulent discharge through an perianal hole. During the colonoscopy procedure, we found many ulcers in the ascending, transverse and descending colon.We also found an elevated lesion of about 5 cm in the rectum. We used hematoxylin - eosin and Gomori-Grocott stain in the biopsies and identified many microorganisms inside macrophages which were compatible with histoplasmosis. ELISA tests for HIV, HTLV I- II were negative. Colon and rectal histoplasmosis in an immunocompetent patient is extremely rare. There are few cases of colonic histoplasmosis reported.

[Colon and rectum histoplasmosis in a patient from Peru]. / Histoplasmosis del colon y recto en un paciente de Perú.

We report a case of a male patient of 52 years old with a 3 months history of pushing, tenesmus, hematochezia, pain while defecating, lost of 18 kg of weight, fever, fecaloid and purulent discharge through an perianal hole. During the colonoscopy procedure, we found many ulcers in the ascending, transverse and descending colon.We also found an elevated lesion of about 5 cm in the rectum. We used hematoxylin - eosin and Gomori-Grocott stain in the biopsies and identified many microorganisms inside macrophages which were compatible with histoplasmosis. ELISA tests for HIV, HTLV I- II were negative. Colon and rectal histoplasmosis in an immunocompetent patient is extremely rare. There are few cases of colonic histoplasmosis reported.

Cryptococcosis Presenting as a Colonic Ulcer in a Kidney Transplant Recipient: A Case Report.

We present a case of a 59-year-old woman with Chagas disease who received a kidney transplant. At month 44 post-transplantation, the patient presented with diarrhea that had persisted for 2 months. Colonoscopy showed a colon ulcer and differential diagnoses included cytomegalovirus, bacteria, or parasite infection; drug-related diarrhea; Crohn's disease; celiac disease; and malignancy. The ulcer tissue was positive for Cryptococcus neoformans. Successful treatment consisted of amphotericin B for 8 days and oral fluconazole (800 mg daily) for 3 months. This case illustrates that a colonic ulcer, although rare, could be cryptococcosis.

[Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis]. / Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis.

BACKGROUND: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. AIMS: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. METHODS: Retrospective-descriptive study using laboratory records. RESULTS: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n=5). CONCLUSIONS: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis / Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis

Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014.

BACKGROUND: Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. OBJECTIVES: To describe aspects of S. bovis endocarditis. METHODS: This is a case series of patients admitted to a cardiac surgery referral center, during the years 2005-2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. RESULTS: Nine patients with S. bovis endocarditis were included; all cases fulfilled the modified Duke criteria. Incidence was 8/220 (4%) in years 2006-2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal findings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. CONCLUSIONS: S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.

Intestinal paracoccidioidomycosis simulating colon cancer.

We report a case of intestinal involvement of Paracoccidioidomycosis, in a patient considered to have colonic cancer. The diagnosis of this mycosis should be considered when an abdominal mass associated with intra-lesional calcifications on X-ray is observed. CT scans increase the findings.

[Colonic perforation secondary to ileocecal tuberculosis. Report of one case]. / Perforación del colon secundaria a tuberculosis ileocecal. Caso clínico.

We report a 44 years old male, presenting with an eight months history of right lower quadrant pain, diarrhea and weight loss. Colonoscopy showed a proliferative and ulcerated lesion in the cecum, with necrotic areas. Barium enema showed an extensive irregular stenosis with rigidity of cecum and ascending colon. The endoscopic biopsy showed numerous granulomas with giant multinucleated cells of Langhans type. A right colectomy was performed with a good postoperative evolution. Anti tuberculosis treatment was started two weeks later and was well tolerated. The patient is currently asymptomatic after two years of followup.

Intestinal spirochetosis: first cases reported in Brazil and the use of immunohistochemistry as an aid in histopathological diagnosis.

Colonization of the colon and rectum by intestinal spirochetes is detected for the first time in Brazil in 4 of 282 (1.41%) patients who had undergone sigmoidoscopy and/or colonoscopy with a histopathological diagnosis of chronic non specific-colitis. This frequency is probably underestimated, since surgically obtained specimens were not considered in the present study. Histopathological diagnosis was performed using routine stains like hematoxylin-eosin which showed the typical, of 3-microns thick hematoxyphilic fringe on the brush border of the surface epithelium, and by silver stains like the Warthin-Starry stain. Immunohistochemical procedures using two, polyclonal, primary antibodies, one against Treponema pallidum and the other against Leptospira interrogans serovar copenhageni serogroup Icterohaemorrhagiae cross-reacted with spirochetal antigen/s producing a marked contrast of the fringe over the colonic epithelium, preserving the spiral-shaped morphology of the parasite. In one case with marked diarrhea, immunohistochemistry detected spirochetal antigen/s within a cell in an intestinal crypt, thus demonstrating that the infection can be more widely disseminated than suspected using routine stains. Immunohistochemical procedures, thus, greatly facilitate the histological diagnosis of intestinal spirochetosis and may contribute to a better understanding of the pathogenesis of the disease. Transmission and scanning electron microscopy performed in one case showed that the spirochete closely resembled the species designated as Brachyspira aalborgi.

Ulceras colónicas en pacientes HIV (+) / Colonic ulcers in HIV (+) patients

Uno de los hallazgos endoscópicos rectocolónicos característicos es la presencia de úlceras colónicas, que pueden corresponder a diferentes diagnósticos. Entre enero de 1989 y mayo de 1993, practicamos 28 colonoscopías y 42 rectocospías en pacientes HIV +. En todos los casos se practiron estudios histológicos, parasitológicos, bacteriológicos, virológicos y micológicos en tejido biopsiado. En 18 de ellas (26 por ciento) encontramos úlceras rectocolónicas (excluimos aquí las úlceras anales y las de ileon terminal). Se trató de 16 hombres y 2 mujeres, con edad promedio de 31, 21 años (20-47), de los cuales 14 eran hombres homosexuales, 2 adictos endovenosos, 1 hemofílico y una mujer heterosexual. Los síntomas fueron hematoquezia en 15, 7 con proctorragia, 6 con enterorragia, y 2 con ambas manifestaciones. Los restantes presentaban todos diarrea crónica, pérdida de peso, secreción anal, astenia, fiebre, constipación y anemia en casos aislados. Los diagnósticos fueron: 6 citomegalovirus rectocolónicos (todos en el presente año). Otros patógenos oportunistas asociados fueron: una TBC intestinal, un herpes rectal y un linfoma tipo Burkitt. En 9 pacientes no se halló agente etiológico asociado pese a la búsqueda sistemática de los mismos. En tres casos los oportunistas hallados fueron marcadores de SIDA en esos pacientes.

Ulceras colónicas en pacientes HIV (+) / Colonic ulcers in HIV (+) patients

Uno de los hallazgos endoscópicos rectocolónicos característicos es la presencia de úlceras colónicas, que pueden corresponder a diferentes diagnósticos. Entre enero de 1989 y mayo de 1993, practicamos 28 colonoscopías y 42 rectocospías en pacientes HIV +. En todos los casos se practiron estudios histológicos, parasitológicos, bacteriológicos, virológicos y micológicos en tejido biopsiado. En 18 de ellas (26 por ciento) encontramos úlceras rectocolónicas (excluimos aquí las úlceras anales y las de ileon terminal). Se trató de 16 hombres y 2 mujeres, con edad promedio de 31, 21 años (20-47), de los cuales 14 eran hombres homosexuales, 2 adictos endovenosos, 1 hemofílico y una mujer heterosexual. Los síntomas fueron hematoquezia en 15, 7 con proctorragia, 6 con enterorragia, y 2 con ambas manifestaciones. Los restantes presentaban todos diarrea crónica, pérdida de peso, secreción anal, astenia, fiebre, constipación y anemia en casos aislados. Los diagnósticos fueron: 6 citomegalovirus rectocolónicos (todos en el presente año). Otros patógenos oportunistas asociados fueron: una TBC intestinal, un herpes rectal y un linfoma tipo Burkitt. En 9 pacientes no se halló agente etiológico asociado pese a la búsqueda sistemática de los mismos. En tres casos los oportunistas hallados fueron marcadores de SIDA en esos pacientes. (AU)