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Copyright © 2015 Caroldoey, All trademarks are the property of the respective trademark owners. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. The patient was a fifty-one year old female with an approximate 10 year history of HIV infection. Cytologic diagnosis on esophageal brushing: Intracellular fungus consistent with histoplasma capsulatum.
Histologic diagnosis on esophageal biopsy: Ulcerated squamous mucosa showing clusters of histiocytes filled with non-budding yeast compatible with Histoplasma organisms.
Clinical Follow-up: Confirmatory laboratory test was a positive urinary histoplasma antigen.

Discussion: Histoplasma capsulatum is a dimorphic fungus endemic to the Ohio and Mississippi River Valleys, as well as to the Caribbean. Immunocompromised hosts lack cellular immune defenses, making Histoplasma a frequently encountered opportunistic pathogen. Her presenting complaints were pain and difficulty swallowing and occasional centralized chest pain made worse by eating. An esophagogastroduodenoscopy was performed which showed diffusely ulcerated and cobblestoned mucosa involving almost the entire length of the esophagus.
Esophageal involvement with histoplasmosis is an uncommon finding, but has been reported in the literature.
Mediastinal histoplasmosis presenting with esophageal involvement and dysphagia: case study.
Esophageal obstruction caused by mediastinal histoplasmosis: beneficial results of operation.
The pathogenesis is not completely understood, however, Histoplasma yeasts are phagocytosed by macrophages. The two most common scenarios are: expansion of mediastinal lymphadenopathy (with the possible complication of mediastinal fibrosis) secondarily involving the esophagus and in cases of disseminated disease. She had been on antiretroviral therapy in the past, but was not currently taking the medications.

An esophageal brush specimen was submitted to cytology, and a corresponding biopsy was sent to surgical pathology.
Tadros, MD, and Dean Willis, SCT of Grady Memorial Hospital and Emory University Hospital, Atlanta GA. Initial clinical workup included chest radiograph, PPD placement, and three sputum cultures. In normal hosts, the infection is controlled by helper T-cells and cytokines that activate macrophages to kill the engulfed organisms.
Although our initial finding in this patient was the esophageal involvement, this patient was later found to have reactivated pulmonary disease, making the findings in the esophagus part of the disseminated process. A change in diet and trial of Diflucan lead to complete resolution of symptoms, therefore a working diagnosis of candidal esophagitis was rendered.

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