"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.
Kibria
Rizwan
R
Department of Gastroenterology, Wright State University, SOM, 4100 W.Third Street, Dayton, Ohio 45428, USA. rekibria@gmail.com
Bari
Khurram
K
Ali
Syed A
SA
Barde
Christopher J
CJ
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