HISTOPLASMOSIS OF THE COLON IN PATIENTS WITH AIDS - IMAGING FINDINGS IN 4 CASES

OBJECTIVE. The purpose of this study was to describe and illustrate th e radiographic findings of colonic histoplasmosis in patients with AID S. SUBJECTS AND METHODS. Four HIV-positive patients were admitted beca use of fever, abdominal pain, tenderness, weight loss, and diarrhea. O ne patient had known disseminated histoplasmosis, one had esophageal m oniliasis, and two had no other known opportunistic infections or tumo rs. All four patients had barium enemas, and two had abdominal CT exam inations. The diagnosis was established via colonoscopic biopsy in thr ee patients and with surgery in one patient. RESULTS. Barium enema in two patients showed separate, short, apple-core lesions in the transve rse and descending colon. In one patient, a single lesion in the ascen ding colon mimicked colonic carcinoma. One patient had segmental invol vement of the ascending colon, compatible with inflammatory bowel dise ase. CT examination revealed circumferential thickening of the wall of the colon with adjacent lymphadenopathy of mixed attenuation.Three pa tients responded to medical therapy, and one patient remained symptoma tic and was found on a follow-up CT examination to have significant re currence of retroperitoneal lymphadenopathy. CONCLUSION. Colonic histo plasmosis in patients with AIDS has protean radiographic features and can mimic colonic carcinoma. In these patients, histoplasmosis should be part of the differential diagnosis, particularly when several colon ic lesions are detected, associated regional and retroperitoneal lymph adenopathy is present, and the patient is living or has lived in an en demic area.