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

Rihana, Nancy; Kandula, Manasa; Velez, Ana Paula; Dahal, Kumud; O'Neill, Edward B.

doi:10.1155/2014/879535

Cited by 30 publications

(19 citation statements)

References 20 publications

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“…This case, contracted 10 years later, serves as the first to our knowledge that illustrates granulomas and intracytoplasmic yeast-like fungi within the liver parenchyma of the transplant allograft. Furthermore, only three other reports are of isolated granulomatous hepatitis, and ours serves as the only one to report this finding in a liver transplant allograft [ 4 – 6 ]. Immunocompetent hosts can often develop antigen-specific CD4 T lymphocyte-mediated immune response which can limit the disease.…”

Section: Discussionmentioning

confidence: 73%

Histoplasmosis hepatitis after orthotopic liver transplantation

Washburn

Galván

Dhingra

et al. 2017

Journal of Surgical Case Reports

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Histoplasmosis is an endemic mycosis in the Ohio and Mississippi River valleys and can cause disseminated infection in immunocompromised hosts. Disseminated histoplasmosis is often respiratory in nature and most cases in transplant patients occur within 2 years post-transplantation. A 32-year-old male on mycophenolate and tacrolimus who underwent an orthotopic liver transplantation 10 years prior presented with generalized body aches, fevers, mild congestion, dysuria and elevated transaminases. Liver biopsy revealed epithelioid granulomas with narrow-based budding yeast, suggesting histoplasma. Liver involvement in disseminated histoplasmosis is well characterized however the disease is usually pulmonary in origin. Only three other case reports describe isolated granulomatous hepatitis, and this is the first to our knowledge to occur in a liver transplant allograft. A high index of suspicion is essential for diagnosis and prompt treatment of histoplasmosis in transplant patients considering their immunocompromised state.

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Section: Discussionmentioning

confidence: 73%

Histoplasmosis hepatitis after orthotopic liver transplantation

Washburn

Galván

Dhingra

et al. 2017

Journal of Surgical Case Reports

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“…The dimorphic fungus Histoplasma capsulatum causes the most common primary mycosis in the United States, which can often progress to disseminated histoplasmosis in immunocompromised patients [1,2]. Liver involvement because of disseminated histoplasmosis is common.…”

Section: Image Of the Issuementioning

confidence: 99%

“…Liver involvement because of disseminated histoplasmosis is common. However, liver histoplasmosis as an initial sign of histoplasmosis, without lung involvement is very rare [1][2][3]. A high index of suspicion for histoplasmosis is required especially for renal transplant recipients.…”

Section: Image Of the Issuementioning

confidence: 99%

Granulomatous Hepatitis: A Rare Primary Manifestation of Disseminated Histoplasmosis in a Renal Transplant Recipient

Kothadia

Kone

Giashuddin

2019

JGLD

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A 41-year-old white male with past medical history significant for renal transplantation in 2007, was admitted with malaise, fever and worsening jaundice. Four days before admission he underwent an uneventful laparoscopic cholecystectomy with liver biopsy. Liver biopsy revealed moderate to severe mixed portal tract infiltration with unknown etiology.Physical examination was benign except the cervical lymphadenopathy. His laboratory tests showed anemia, leukopenia, and thrombocytopenia. Liver function tests were altered: aspartate aminotransferase 70 (3-50) IU/L, alanine aminotransferase 68 (3-60) IU/L, alkaline phosphatase 1351 (20-125) IU/L, total bilirubin 10.2 (0.2-1.3) mg/dL. Tests for viral hepatitis, autoimmune markers, serum rapid plasma reagin (RPR), QuantiFERON-TB Gold, Ebstein-Barr virus (EBV), and cytomegalic virus (CMV) were all negative. Blood and urine cultures were negative. He was tested positive for human immunodeficiency virus (HIV). Computed tomography (CT) of the abdomen showed heterogeneous lesions in the right hepatic lobe suspicious for infection with mesenteric and retroperitoneal lymphadenopathy (Fig.

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“…Histoplasmosis can be found worldwide, but is particularly seen in North and Central America, being the most common endemic mycosis in the USA. 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 20. Histopathological recovery of microorganisms is usually performed by periodic-acid Schiff or H&E stain, which showed no microorganisms in our liver biopsy 21.…”

Section: Discussionmentioning

confidence: 90%

Erythema induratum of Bazin and Ponçet's arthropathy as epiphenomena of hepatic tuberculosis

et al. 2016

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A 42-year-old black woman presented with fever, polyarthritis, livedo reticularis, subcutaneous calf nodules and hepatomegaly. She had been diagnosed with depression 6 weeks prior. Blood analysis showed anaemia, elevated erythrocyte sedimentation rate and C reactive protein, elevated liver enzymes, and positive antinuclear and antiribonucleoprotein antibodies. Abdominal ultrasound revealed heterogeneous hepatomegaly with necrotic lymphadenopathy around the caeliac trunk and splenic hilum. We considered the following diagnoses: lymphoma, connective tissue disease, tuberculosis and sarcoidosis. Subcutaneous nodule histology was compatible with erythema induratum of Bazin, and liver biopsy evidenced granulomatous hepatitis. Although microbiological examinations were negative in tissue samples, a presumptive diagnosis of hepatic tuberculosis was admitted. Having excluded other causes, erythema of Bazin, livedo reticularis and polyarticular involvement (Ponçet's arthropathy) were accepted as immunological epiphenomena associated with tuberculosis. Empirical antituberculous treatment was started and after 3 weeks the patient improved substantially. This clinical response was a further confirmation of the diagnosis.

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

Cited by 30 publications

References 20 publications

Histoplasmosis hepatitis after orthotopic liver transplantation

Histoplasmosis hepatitis after orthotopic liver transplantation

Granulomatous Hepatitis: A Rare Primary Manifestation of Disseminated Histoplasmosis in a Renal Transplant Recipient

Erythema induratum of Bazin and Ponçet's arthropathy as epiphenomena of hepatic tuberculosis

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