Table 1 Summary of Case Reports of Cholestasis in Disseminated Histoplasmosis

Wee et al. (2009) [16]

59 year old male with recent travel to Indonesian farmland presented with 1 month of fever, icterus and tea colored urine

AST&ALT normal

ALP 528 U/L

T.Bili 15.2 mg/dL

D.Bili 11.3 mg/dL

+ Serum Ab

+ Urine Antigen (8.45 EIA)

+ BCx H.Capsulatum

GMS: intracellular budding yeast 2–3 μm in diameter [Verified with bone marrow aspirate]

IV Amphotericin B (dose and duration not presented) without complications

van Welzen et al. (2013) [18]

74 year old female with history of necrotizing scleritis on prednisone, methotrexate and adalimumab presented with shortness of breath

AST 129 U/L

ALT 111 U/L

ALP > 2100 U/L

T.Bili 3.7 mg/dL

D.Bili 2.2 mg/dL

+ PCR and culture with liver tissue specimen, colonic tissue specimen, and bronchial fluid

+ BCx H.Capsulatum

- Serum Ab

H&E: portal infiltrates composed of lymphocytes, histiocytes and multinuclear histiocytic cells

PAS: multinuclear histiocytic cells containing fungal organisms

GMS: multinuclear histiocytic cells containing fungal organisms

IV Amphotericin B for 2 weeks, then Itraconazole 200 mg BID for 1 year. The patient’s hospitalization was complicated by hematochezia.

Rihana et al. (2014) [17]

66 year old female with history of rheumatoid arthritis on methotrexate on infliximab with recent travel to Kansas presented with 3 weeks of fever, chills, tachycardia, and painless jaundice

AST 173 U/L

ALT 252 U/L

ALP 375 U/L

T.Bili 4.2 mg/dL

+ Serum Antigen > 19 ng/mL

+ Cx on Bronchilolar Lavage

H&E: fungal organisms within areas of granulomatous inflammation

GMS: round to ovoid 2–4 μm narrow based budding yeast

Acid Fast: negative

Immunohistochemical: negative

IV Amphotericin B was started, then due to acute kidney injury, was changed to Itraconazole. This was stopped and changed to Voriconazole due to GI bleed

Gill et al. (2017) [20]

61 year old female with history of rheumatoid arthritis presented with fever, chills, abdominal pain and jaundice while on hydroxychloroquine

AST 449 U/L

ALT 745 U/L

ALP 1045 U/L

T.Bili 11.6 mg/dL

D.Bili 2.4 mg/dL

GGT 620 U/L

+ BCx H.Capsulatum

+ Urine Antigen

Liver biopsy not performed

IV Amphotericin B + Voriconazole were started. The patient was discharged on Itraconazole

Kothadia et al. (2017) [19]

41 year old male with history of kidney transplant on immunosuppression presented with fever, malaise and jaundice

AST 70 U/L

ALT 68 U/L

ALP 1351 U/L

T.Bili 10.2 mg/dL

+ Urine Antigen > 25 ng/mL

+ HIV

H&E: non-necrotizing granulomatous inflammation with histiocytes

GMS: Round to ovoid, narrow budding yeasts

Patient passed away secondary to multiorgan failure in the setting of sepsis