Cholestasis and disseminated histoplasmosis in a psoriatic patient on infliximab: case report and review of literature

• Main Authors: Steven Park, Janice Cheong, Kaitlin Kyi, Jose Aranez, Sohaib Abu-Farsakh, Christa Whitney-Miller, Bandar Al-Judaibi, Marie Laryea
• Format: Article
• Language: English
• Published: BMC 2020-05-01
• Series: BMC Gastroenterology
• Subjects: Histoplasma capsulatum; Histoplasmosis; Granulomatous hepatitis
• Online Access: http://link.springer.com/article/10.1186/s12876-020-01290-3

Abstract Background Histoplasma capsulatum is the most common endemic mycosis in the United States and frequently presents as an opportunistic infection in immunocompromised hosts. Though liver involvement is common in disseminated histoplasmosis, primary gastrointestinal histoplasmosis of the liver in absence of lung involvement is rare. Similarly, cholestatic granulomatous hepatitis in liver histoplasmosis is rarely seen. Case presentation We present a rare case of primary gastrointestinal histoplasmosis manifesting with acute granulomatous hepatitis and cholestasis in a 48-year-old female with psoriatic arthritis, receiving methotrexate and infliximab. The epidemiology, risk factors, clinical presentation, diagnosis, and treatment of histoplasmosis is discussed. Furthermore, we review the published cases of biopsy-proven disseminated histoplasmosis with cholestatic jaundice to highlight histoplasmosis involvement in the liver. Conclusion Histoplasmosis should be considered in immunosuppressed patients with fever, chills, abdominal pain and cholestasis with progressive jaundice, particularly in subjects without evidence of biliary obstruction. Future studies are needed to accurately assess the risk of this fungal infection, specifically in patients on immunomodulatory therapy for autoimmune disease.