“Ohio River Valley Fever” Presenting as Isolated Granulomatous Hepatitis: A Case Report

• DOI: 10.1097/smj.0b013e3181a56b7e
• Publication Date: 2011-04-06T22:00:03Z
• Authors: Rizwan Kibria; Khurram Bari; Syed A. Ali; Christopher J. Barde
• Keywords: Adult; Antifungal Agents; Granuloma; Hepatitis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Liver; Amphotericin B; Humans; Female; Histoplasmosis

Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.