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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
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.
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.
