PMC5817307_01
CT abdomen/pelvis with IV contrast (axial). White arrows: mesenteric masses found to be histoplasmosis after surgical resection. White arrowhead: free air in the mesentery from jejunal perforation.
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CT of the abdomen and pelvis (Figure 1) revealed gas bubbles scattered throughout the left mesentery, multiple areas of small bowel thickening and edema, evidence of free fluid in the abdomen, and mesenteric masses (Figure 1).
Contrasted CT of the chest showing a 16 mm right lower lobe nodule.
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The CTA showed 16 mm right lower lobe nodule (Figure 2), as well as a 6 mm left upper lobe nodule.
(a) Low power H and E stain showing normal small bowel (white arrow) compared with ulcerated small bowel (black arrow). (b) Higher power H and E stain showing small bowel necrosis and inflammation. (c) GMS silver stain demonstrating numerous histoplasmosis (black arrows).
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Histological examination of surgical specimens showed necrotic tissue with yeast consistent with histoplasmosis (Figures 3-3).