Colonic coinfection of histoplasma and cytomegalovirus mimicking carcinoma in a patient with HIV/AIDS.

A 45-year-old man with a known history of hemophilia and AIDS presented with right upper quadrant pain for 3 weeks, associated with weight loss and fever. He had declined antiviral therapy. Physical examination revealed tenderness in the right upper quadrant and splenomegaly. Laboratory tests included the following: white blood cell count, 2000/cmm (reference range, 4000-10,000/cmm), hemoglobin, 11.1 g/dL (13.5-17.0 g/dL), albumin, 3.7 g/dL (3.5-5.0 g/dL), and CD4 count, 17/cmm (410-1590/cmm). CT scan revealed an apple-core lesion at the cecum, suggestive of carcinoma (A). At colonoscopy, a large mass was found in the proximal ascending colon, distal to the cecum (B). The bleeding shown in B was caused by the biopsy. The cecum, and ascending and transverse colon were ulcerated.