Histoplasma capsulatum is the most common endemic mycosis in the United States and can cause disseminated histoplasmosis in immunocompromised patients.1 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.
Address correspondence to Jose D. Debes, Department of Medicine, University of Minnesota, 2001 6th Street SE, R3-226, Minneapolis, MN 55455. E-mail:firstname.lastname@example.org
Authors’ addresses: Brittany Hjermstad, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, E-mail: email@example.com. Dale Snover, Department of Pathology, University of Minnesota System, Minneapolis, MN, E-mail: firstname.lastname@example.org. Jose Daniel Debes, Department of Infectious Disease and Gastroenterology, University of Minnesota, Minneapolis, MN, E-mail: email@example.com