International Journal of STD & AIDS > Volume 19, Number 12 > Pp. 864-865

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Gastrointestinal histoplasmosis in an HIV-infected patient living in a non-endemic area

D Peppa MRCP ^* , I Plumb MRCP ^*, J du Parcq MBBS , S Taylor FRCR  and R F Miller FRCP ^*  

^* T8, University College London Hospitals, London NW1 8BU; Research Department of Infection and Population Health, Division of Population Health, Royal Free and University College London Medical School, University College London, London WC1E 6JB, UK; Department of Histopathology, University College London Hospitals, London WC1E 6JJ; Department of Imaging, University College London Hospitals, London NW1 8BU, UK

View larger version (121K): [in this window] [in a new window]   Figure 1 (a) Axial intravenous contrast-enhanced computed tomography (CT) image through the lower abdomen which shows mixed attenuation mesenteric lymphadenopathy (white arrows). (b) Axial intravenous contrast-enhanced CT image through the upper abdomen showing jejunal wall thickening (white arrows), which is apparent despite collapse of small bowel loops. (c) Axial intravenous contrast-enhanced CT image through the lower abdomen which demonstrates partial resolution of previously noted lymphadenopathy (white arrows). The small bowel is now dilated. (d) Axial half Fourier Acquisition Single shot Turbo spin Echo (HASTE) MR image through the lower pelvis acquired 40 minutes after oral ingestion of 1000 mL of 0.2% locust bean gum with 2% mannitol solution. There is a short tight ileal stricture (black arrow) with upstream small bowel dilatation. There is a lack of soft tissue thickening at the stricture site.

 

View larger version (133K): [in this window] [in a new window]   Figure 2 (a) Image obtained at endoscopy, showing a duodenal plaque-like lesion, with macroscopically normal surrounding mucosa. (b) The duodenal biopsy shows markedly abnormal mucosa with widespread blunting of villi and loss of duodenal crypts. Haematoxylin & eosin stain; original magnification = x40. (c) The lamina propria is expanded by an infiltrate of macrophages, each containing numerous ovoid organisms. These organisms are periodic acid Schiff stain positive and each is circumscribed by a clear halo. Ziehl-Neelsen staining is negative; original magnification = x200. (d) The organisms show weak birefringence under polarized light.

 

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