Disseminated liver histoplasmosis in an immunocompetent individual cured by liver transplantation and voriconazole from China: A case report

Abstract

BACKGROUND

Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals. Its manifestation varies and lacks specificity. This study reports a case of primary disseminated liver histoplasmosis in a normal host presenting as liver failure cured by liver transplantation and voriconazole.

CASE SUMMARY

A 43-year-old Chinese man with intermittent fever, malaise, jaundice and extreme hepatomegaly for more than 40 days was admitted to the Second Xiang-ya Hospital. The patient was immunocompetent and lacked a definitive history of exposure. His condition deteriorated to liver failure, and he promptly underwent liver transplantation to ensure survival. One year later, the patient presented with severe gastrointestinal symptoms, including fever, abdominal pain, and diarrhea. Subsequently, tissue samples acquired via gastrointestinal endoscopy were subjected to pathological examination and next-generation sequencing analysis. Through a comprehensive amalgamation of clinical presentation, biopsy pathology, and next-generation sequencing analysis, the patient was ultimately diagnosed with disseminated hepatic histoplasmosis. The patient achieved complete recovery after 6 months of voriconazole treatment.

CONCLUSION

In patients with chronic-hepatitis-B having atypical symptoms, histoplasmosis can be a differential diagnosis. Voriconazole is effective in treating histoplasmosis.

Keywords: Histoplasma; Disseminated histoplasmosis; Immunocompetence; Liver transplantation; Voriconazole; Case report

Core Tip: Disseminated histoplasmosis in immunocompetent populations presenting solely as liver involvement and progressing to liver failure is rare, and there is no reported case of histoplasmosis cured by liver transplantation. Voriconazole is commonly used for fungal infections, but its experience in treating histoplasmosis is limited. In our report, we detail the case of the world’s first patient to receive liver transplantation surgery for liver failure caused by hepatic histoplasmosis, characterized by a complex and varied progression. After a comprehensive analysis, the patient was ultimately diagnosed and achieved complete recovery with the surgery and voriconazole.