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Introduction: Congenital fibrinogen disorders are rare conditions in which there are quantitative and qualitative alterations of factor I; the vast majority of patients are asymptomatic. Case presentation: A 19-year-old female patient with a history of congenital hypofibrinogenemia presented with spontaneous vulvar hematoma along with hypotension, tachycardia, stupor and hematoma of 20cm in the right labium majus. On admission, the young woman had hemoglobin 6.6 g/dL, fibrinogen 74 mg/dL and prolonged clotting times. She received red blood cells transfusion and cryoprecipitates, followed by surgical drainage and intravenous fibrinogen replacement, adjusting the dose according to fibrinogen levels in plasma. The patient presented progressive improvement without hemorrhagic recurrence and fibrinogen levels within the target values until hospital discharge. Discussion: Afibrinogenemia and hypofibrin­ogenemia are part of the quantitative factor I disorders; in the first case, there is total absence of circulating fibrinogen, and in the second case the levels are below 150 mg/dL. Sponta­neous vulvar hematoma as a severe hemorrhagic manifestation is not frequent in symptomatic patients; its treatment is based on fibrinogen replacement in an individualized manner and surgical management when required. Conclusion: Hypofibrinogenemia is a rare dis­ease, and fibrinogen replacement is one of the mainstays of treatment.

Introduction: Histoplasmosis is an opportu­nistic granulomatous fungal infection. Peritoneal histoplasmosis (PH) is a rare form of dissem­inated histoplasmosis (DH). Case description: A 44-year-old male pa­tient with history of HIV infection, systemic lupus erythematosus with lupus nephritis, and chronic kidney disease on peritoneal dialysis, presented with recurrent ascites without clear etiology in the serial study of ascitic fluid. Con­trast computed tomography of the abdomen showed a nonspecific peritoneal nodule, for which laparoscopy and biopsy were performed, identifying Histoplasma capsulatum infection. The subject received 15 days of in-hospital treatment with amphotericin B deoxycholate with good evolution, no recurrence of ascites, and indefinite outpatient management with itraconazole. Discussion: The first case of PH was described in 1970 but this is the first case reported in Co­lombia. Most cases of PH have been associated with peritoneal dialysis. Its diagnosis is based on the study of ascitic fluid and its treatment follows the guidelines of other forms DH. Conclusions: PH is a rare entity that requires high clinical suspicion, especially in immuno­compromised patients.