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Related Experiment Video

Updated: Sep 27, 2025

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Case Report: Histoplasma Hepatitis Presenting as Common Bile Duct Obstruction.

Brittany Hjermstad1, Dale Snover2, Jose D Debes1,2

  • 1Department of Medicine, Gastroenterology and Hepatology, Hennepin Healthcare, Minneapolis, Minnesota.

The American Journal of Tropical Medicine and Hygiene
|April 11, 2022
PubMed
Summary

Histoplasmosis, a fungal infection, can affect the liver and be difficult to diagnose, especially in immunocompromised patients. This case highlights a rare presentation mimicking biliary obstruction, successfully treated with itraconazole.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunocompromised Host

Background:

  • Histoplasma capsulatum is a prevalent endemic fungus in the US, frequently causing disseminated disease in immunocompromised individuals.
  • Hepatic involvement is a known complication of histoplasmosis but poses diagnostic challenges.
  • Adalimumab, an immunosuppressive biologic, is used for rheumatoid arthritis and can increase susceptibility to opportunistic infections.

Observation:

  • A 50-year-old woman on adalimumab presented with right upper quadrant pain, fever, jaundice, and dyspnea.
  • Initial investigations suggested biliary obstruction (Mirizzi syndrome) and COVID-19, but treatment was ineffective.
  • Bronchoscopy revealed budding yeast, and liver biopsy confirmed Histoplasma capsulatum.

Findings:

  • The patient's symptoms were attributed to disseminated histoplasmosis with hepatic involvement.
  • Microscopic examination (budding yeast) and culture (H. capsulatum) confirmed the fungal etiology.
  • Prompt initiation of itraconazole therapy led to clinical improvement.

Implications:

  • This case underscores the importance of considering opportunistic fungal infections like histoplasmosis in immunocompromised patients with atypical presentations.
  • Diagnostic challenges in hepatic histoplasmosis necessitate a high index of suspicion and thorough investigation.
  • Timely diagnosis and appropriate antifungal treatment are crucial for managing disseminated histoplasmosis and improving patient outcomes.