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Case Reports in Medicine
Volume 2014, Article ID 879535, 4 pages
http://dx.doi.org/10.1155/2014/879535
Case Report

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

1Department of Infectious Diseases, University of South Florida, 1 Tampa General Circle G323, Tampa, FL 33606, USA
2University of South Florida, Tampa, FL 33606, USA
3Department of Infectious Diseases, University of South Florida, Tampa, FL 33606, USA
4Department of Infectious Diseases, University of Illinois, One Illini Drive, Peoria, IL 61605-2576, USA
5Department of Pathology, Tampa General Hospital, Tampa, FL 33606, USA

Received 23 February 2014; Accepted 28 May 2014; Published 9 June 2014

Academic Editor: Larry W. Moreland

Copyright © 2014 Nancy A. Rihana et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.