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Julio Alejandro Murra-Saca MD.
Gastroenterologist, Coloproctologist
Tel : (503) 226-3131, (503) 225-3087, Celular (503) 887-2507
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Edificio Centro Scan, Colonia Médica, San Salvador, El Salvador.

 

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Notes on Cyber Gastroenterology

 

Histoplasmosis is a disease caused by colonization of histoplasma, a fungus that is normally found in any humid environment in nature. Histoplasma may invade internal organs, especially the lungs and the eyes. Patients with lowered immune systems (HIV, Chemotherapy patients, etc.) may be more prone to contract this disease. This case involves a 3 year old child,born on May 3, 1999. The patient first consulted a pediatrician with clinical history of diarrhea, abdominal pain and growth retardation, of one year of evolution, and was treated symtomatically after a proper laboratory work-up. One month after the initial visit patient presents with rectal hemorrhage and was hospitalized at a local hospital ( Hospital Centro de Emergencias ). I was called to examine the patient from a gastro-enterologic point of view. Digital rectal examination disclosed an ulcerated nodule at the pectinea line
at the rectum, which is rare in children Video-colonoscopy was performed and biopsy specimen were taken. Histoplasma Capsulatum was reported by pathology department. Later studies revealed a deficiency in the production of the IgG Immunoglobulin for this patient.

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Histoplasmosis lesion of the rectum. Observe the ulcerated and nodular aspect at the first rectal valve.
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Video-colonoscopy of a three year old child with Histoplasmosis of the colon. Note the indurated ucerated lesion..

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Similar lesion of the same etiology.

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Picture of the first endoscopic images reported in world literature of Histoplasmosis of the Colon.
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Observe the nodular aspect as well as the multiple indurations and ulcerations , causing an important stenosis at the recto-sigmoidal junction, which prevents further passage of the endoscope.

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Endoscopic image of the above described lesion. Close-up view of the stenosis.

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Endoscopic image of the stenotic area caused by colonization of this fungus.

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Further endoscopic image of the area infected by histoplasma capsulatum.

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