Year 2026 / Volume 118 / Number 2
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Gastrointestinal bleeding due to disseminated histoplasmosis in a patient under anti-TNF treatment

105-106

DOI: 10.17235/reed.2024.10432/2024

Irene González Díaz, Cristina Suárez Ferrer, Clara Amiama Roig, Carmen Amor Costa,

Abstract
A 62-year-old woman, originally from Peru, with rheumatoid arthritis under treatment with anti-tumor necrosis factor (anti-TNF) therapy, was admitted due to constitutional syndrome and suspicion of neoplasia. Computed tomography (CT) scan revealed involvement of three segments of the colon, ascites, and likely peritoneal implants. Ascitic fluid analysis showed elevated adenosine deaminase (ADA) levels and lymphocytosis. The patient presented with hematemesis and hematochezia with hemodynamic instability. Upper gastrointestinal endoscopy identified an extensive ulcer in the middle esophagus with a granular base, elevated and defined edges, indeterminate for malignancy and without blood residues. Colonoscopy also revealed multiple extensive ulcers in the transverse colon, with whitish bases and thickened and necrotic-looking surrounding mucosal edges. Histology showed granulomas and yeast-like fungal structures with methenamine silver staining in both tissues, consistent with disseminated histoplasmosis. Antifungal treatment was initiated with good clinical evolution.
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González Díaz I, Suárez Ferrer C, Amiama Roig C, Amor Costa C. Gastrointestinal bleeding due to disseminated histoplasmosis in a patient under anti-TNF treatment. 10432/2024


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Publication history

Received: 25/03/2024

Accepted: 08/04/2024

Online First: 18/04/2024

Published: 09/02/2026

Article Online First time: 24 days

Article editing time: 686 days


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The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
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