Histoplasma capsulatum is the most common endemic mycosis in the United States and usually occurs in certain geographic areas, such as the Mississippi or Ohio River valleys. Histoplasmosis usually causes a mild disease in the immunocompetent but can progress to disseminated disease in patients with impaired immunity. Granulomatous hepatitis as a manifestation of disseminated histoplasmosis in immunocompetent patients is extremely rare. We report the case of a 62-year-old immunocompetent gentleman with a history of histoplasmosis who presented with abdominal pain, elevated liver enzymes, who was diagnosed with granulomatous hepatitis secondary to histoplasmosis.

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prominent infiltration of eosinophils in the lamina propria and the glands, no parasites were identified. Immunostains for CD25 show no evidence of mast cell abnormalities and stains for Helicobacter pylori were negative. The food allergy panel was negative as well as repeated stool tests for ova and parasites. The patient was started on 40mg of prednisone for two weeks and her abdominal pain dramatically improved. (Figure ) Discussion: EoG is an inflammatory and immune mediated disorder characterized by the infiltration of eosinophils in the gastric mucosa. Clinical manifestations are variable and nonspecific. Laboratory tests are significant for elevated peripheral eosinophil count, and IgE level. Endoscopy is essential for diagnosis, with histology showing more than 30 eosinophils per HPF in at least 5HPFs in the absence of known associated causes of eosinophilia. Steroids are the mainstay of therapy, however, there is a high chance of disease recurrence after discontinuing steroids. Food-elimination diet has been tried with success. For induction and maintenance of remission, limited studies have shown that use of Immunosuppressive drugs, leukotriene inhibitors, and immunomodulators can be used. When routine workup and treatment for chronic abdominal pain is unrevealing, clinicians should consider EoG when pathological specimens show elevated eosinophils, and consider treatment with steroids.

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