SYNOPSIS A 61-year-old woman presented with malaise, intermittent fever, weight loss, and epigastric pain. Histoplasma capsulatum was eventually isolated from a liver biopsy and from the bone marrow and the patient was successfully treated with amphotericin B.Disseminated histoplasmosis is very rarely seen in Great Britain; there have been only 11 reported cases, with positive cultures in eight (Macleod, Murray, Davidson, and Gibbs, 1972 six-month history of malaise, weight loss, and intermittent fever. She also complained of epigastric pain and flatulence. The only abnormal physical findings were a persistent lowgrade pyrexia and an enlarged, tender liver. The only abnormalities revealed on initial investigation were an ESR (Westergren) of 15 to 29 mm/hr, a serum amino-aspartate transferase of 85 iu/l (normal range 25-65 iu/l), and an alkaline phosphatase of 20 KA units/100 ml (normal range 4-13 KA units/ 100 ml). Chest radiography and white count were normal. A liver biopsy was performed on 29 June, and histology showed non-caseating giant cell granulomata but no acid-fast bacilli nor fungi were seen. The biopsy material was not cultured. Tuberculosis was strongly suspected and therapy was begun with isoniazid, para-aminosalicylic acid, and streptomycin. After three weeks these drugs were stopped as the fever continued unabated and her symptoms remained unaltered. A further liver biopsy showed unchanged histology. The specimen was