"Ohio River valley fever" presenting as isolated granulomatous hepatitis: a case report.
Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.
Department of Gastroenterology, Wright State University, SOM, 4100 W.Third Street, Dayton, Ohio 45428, USA. rekibria@gmail.com
Rizwan
R
Kibria
Khurram
K
Bari
Syed A
SA
Ali
Christopher J
CJ
Barde
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology; D006505:Hepatitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology
D000935:Antifungal Agents; D000666:Amphotericin B