A 8- year Bangladeshi girl with disseminated histoplasmosis, presented as chronic liver disease with portal hypertension: a rare case report

Abstract

Background Histoplasmosis is a rare infectious condition with mainly pulmonary involvement. Disseminated histoplasmosis may occur in immunocompromised condition. It can present in different ways but jaundice and ascites is very uncommon. Case presentation A 8- year old girl visited to department of pediatric gastroenterology & nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Child presented with fever, jaundice and abdominal distension for 2 ½ months. There was no history of contact with tuberculosis patient and travelling to kala-azar, malaria endemic zone and no history of previous jaundice, blood or blood product transfusion, history of sib death, family history of jaundice or neuropsychiatric disorder, significant weight loss. On general examination she was fretful, febrile, moderately icteric, mildly pale, vitally stable, severely wasted and moderately stunted, skin survey revealed infected scabies, BCG vaccine mark was absent, generalized lymphadenopathy, hepato-splenomegaly and ascites present. After evaluating the physical findings, several investigations was done including lymphnode biopsy, then the case was finally diagnosed as Disseminated histoplasmosis with portal hypertension. Child was treated with injectable Deoxycholate Amphotericin B for 28 days and improved on follow up. Conclusion We suggest that children presenting with fever, jaundice, lymphadenopathy and hepatosplenomegaly and portal hypertension, disseminated histoplasmosis can be one differential.

Disseminated Histoplasmosis in an Indigenous Child With Malnutrition: A Case Report

“…Symptoms include fever, malaise, weight loss, cough, and diarrhea. On physical examination, most patients are found to have hepatosplenomegaly, lymphadenopathy, and pulmonary crackles [ 1 , 17 ].…”

“…Around 90% of patients have anemia, and 80% of affected children present with leucopenia and thrombocytopenia. Patchy infiltrates with mediastinal and hilar lymph node enlargement are frequently found on chest X-rays [ 1 , 17 ]. When the liver is affected, although transaminases may be elevated, high levels of alkaline phosphatase (≥2100 U/L) are one of the most prominent biochemical laboratory findings [ 19 ].…”

“…Around 90% of patients have anemia, and 80% of affected children present with leucopenia and thrombocytopenia. Patchy infiltrates with mediastinal and hilar lymph node enlargement are frequently found on chest X-rays [1,17].…”

Hepatic Histoplasmosis: An Update

“…Only a few case reports of liverbiopsy-proven histoplasmosis have reported associated cholestasis. 25,[28][29][30] The typical clinical presentations are fever and jaundice in the setting of immunosuppression. Right upper quadrant pain might be confused with biliary colic in cases of cholestatic hepatitis secondary to disseminated histoplasmosis.…”

“…20 Two case reports by Park et al 24 and Kothadia et al 30 describe patients who underwent laparoscopic cholecystectomy for uncertain etiology shortly before being diagnosed with disseminated histoplasmosis. Nahar et al 28 reported a patient with disseminated histoplasmosisthat presented as chronic liver disease with portal hypertension.…”