•  1.

    Barrera L, Alvarez J, Tapias M, Idrovo V, Lopez R, 2013. Granulomatous hepatitis secondary to histoplasma infection after treatment with infliximab. Case Rep Hepatol 2013: 807537.

    • Crossref
    • Search Google Scholar
    • Export Citation
  •  2.

    Rihana NA, Kandula M, Velez A, Dahal K, O’Neill EB, 2014. Histoplasmosis Presenting as granulomatous hepatitis: case report and review of the literature. Case Rep Med2014: 879535.

  •  3.

    Wheat J, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA, 2007. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Disease Society of America. Clin Infect Dis 45: 807825.

    • Crossref
    • Search Google Scholar
    • Export Citation
  •  4.

    Washburn L, Galvan NT, Dhingra S, Rana A, Goss JA, 2017. Histoplasmosis hepatitis after orthoptic liver transplantation. J Surg Case Rep 12: 13.

  •  5.

    Park S, Cheong J, Kyi K, Aranez J, Abu-Farsakh S, Whitney-Miller C, Al-Judaibi B, Laryea M, 2020. Cholestasis and disseminated histoplasmosis in a psoriatic patient on infliximab: case report and review of literature. BMC Gastroenterol 20: 141.

    • Crossref
    • Search Google Scholar
    • Export Citation
  •  6.

    Heninger E, Hogan LH, Karman J, Macvilay S, Hill B, Woods JP, Sandor M , 2006. Characterization of the Histoplasma capsulatum–induced granuloma. J Immunol 177: 33033313.

    • Crossref
    • Search Google Scholar
    • Export Citation
  •  7.

    Koo S, Marty FM, Baden LR, 2010. Infectious complications associated with immunomodulating biologic agents. Infect Dis Clin North Am 24: 285305.

    • Search Google Scholar
    • Export Citation
  •  8.

    Jain N, Doyon J, Lazarus J, Schaefer I-M, Johncilla M, Agoston AT, Dalal AK, Velasquez GE, 2018. A case of disseminated histoplasmosis in a patient with rheumatoid arthritis on abatacept. J Gen Intern Med 33: 769772.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Case Report: Histoplasma Hepatitis Presenting as Common Bile Duct Obstruction

View More View Less
  • 1 Department of Medicine, Gastroenterology and Hepatology, Hennepin Healthcare, Minneapolis, Minnesota;
  • | 2 Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Restricted access

ABSTRACT.

Histoplasma capsulatum is the most common endemic mycosis in the United States and can cause disseminated histoplasmosis in immunocompromised patients. Although hepatic involvement is common with histoplasmosis, it can be challenging to diagnose. We report a case of a 50-year-old woman receiving adalimumab for rheumatoid arthritis who presented with right upper quadrant pain, fever, jaundice, and dyspnea. The initial working diagnosis was biliary obstruction with potential COVID-19 infection. Endoscopic retrograde cholangiopancreatography suggested Mirizzi syndrome, but successful sphincterotomy failed to improve jaundice over subsequent days. Bronchoscopy and liver biopsy were performed, with the first revealing budding yeast and the later growing H. capsulatum. The patient improved with the initiation of itraconazole therapy.

Author Notes

Address correspondence to Jose D. Debes, Department of Medicine, University of Minnesota, 2001 6th Street SE, R3-226, Minneapolis, MN 55455. E-mail:debes003@umn.edu

Authors’ addresses: Brittany Hjermstad, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, E-mail: behjermstad@gmail.com. Dale Snover, Department of Pathology, University of Minnesota System, Minneapolis, MN, E-mail: snoverd@umn.edu. Jose Daniel Debes, Department of Infectious Disease and Gastroenterology, University of Minnesota, Minneapolis, MN, E-mail: debes003@umn.edu

Save