Our patient presented with abdominal pain, weight loss, and fever with evid
ence of oral thrush and pelvic inflammatory disease on exam. Radiographs de
monstrated a small bowel obstruction with free air. An exploratory laparoto
my demonstrated 2 perforations of the distal ileum. Pathologic exam reveale
d features consistent with histoplasmosis. We discuss gastrointestinal invo
lvement of histoplasmosis in AIDS and its treatment.