Disseminated histoplasmosis causing duodenal obstruction in pediatric patient: A case report

Histoplasmosis in children with associated bowel obstruction is rare, and its clinical management is based on data and experience on adult patients. A previously healthy five-year-old girl who recently immigrated to the US from Mexico presented with 5 days of abdominal pain, fever, cough and emesis. On workup, chest x-ray showed diffuse bilateral micro nodules in a miliary pattern, and urine and serum were positive for histoplasma antigen. Barium upper GI series showed distal duodenal obstruction and biopsies taken during endoscopy were positive for histoplasma. Medical therapy with antifungals did not improve the obstruction. On laparotomy, the distal duodenum was obstructed with intrinsic and extrinsic inflammation requiring a diamond duodeno-jejunostomy bypass. Postoperatively, the patient recovered and was discharged home with prolonged antifungals and infectious disease follow up. Our case emphasizes the need for early surgical consultation and careful selection of contrast for luminal imaging. We advocate for an initial attempt at antifungal management to avoid operative treatment during active inflammation and lower surgical risk.