Disseminated histoplasmosis presenting as fever and jaundice.

Dear Editor, Outside of mid-western United States,1 histoplasmosis is endemic in pockets of Asia (like Indonesia) and Europe (Italy, Hungary, Romania, Britain).2 It is caused by H. capsulatum, a fungus found in barns, old houses or soil contaminated with bird droppings. Airborne spores infect those who inhale it. Disease manifestation is myriad, ranging from a sub-clinical infection to an organ-specifi c disease, such as acute pulmonary syndrome, cavitatory lung disease to progressive disseminated histoplasmosis (PDH), the latter commonly seen in immunocompromised hosts, with human immunodefi ciency syndrome.3,4 We report an interesting case of cholestatic jaundice presenting to the physician as a diagnostic dilemma. Our subject was eventually diagnosed with progressive disseminated histoplasmosis after extensive evaluation. Uncommonly, histoplasmosis may present as cholestatic jaundice as in our case report. Also, PDH infrequently occurs in subjects with relatively normal immunity. Gastroenterologists practising in non-endemic regions will therefore need to be mindful of such unusual manifestations of the disease.