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

Kibria, Rizwan; Bari, Khurram; Barde, Christopher J.

doi:10.1097/smj.0b013e3181a56b7e

Cited by 17 publications

(13 citation statements)

References 10 publications

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“…Liver often is involved in the course of progressive disseminated disease usually originating in the lungs. Patients with primarily liver involvement present with nonspecific symptoms like fever of unknown origin, nausea, vomiting, fatigue, weight loss, and elevation of liver function tests as seen in our patient and previously reported cases [12, 13]. …”

Section: Discussionsupporting

confidence: 75%

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Rihana

Kandula

Velez

et al. 2014

Case Reports in Medicine

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Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.

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Section: Discussionsupporting

confidence: 75%

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Rihana

Kandula

Velez

et al. 2014

Case Reports in Medicine

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“…This case, contracted 10 years later, serves as the first to our knowledge that illustrates granulomas and intracytoplasmic yeast-like fungi within the liver parenchyma of the transplant allograft. Furthermore, only three other reports are of isolated granulomatous hepatitis, and ours serves as the only one to report this finding in a liver transplant allograft [ 4 – 6 ]. Immunocompetent hosts can often develop antigen-specific CD4 T lymphocyte-mediated immune response which can limit the disease.…”

Section: Discussionmentioning

confidence: 71%

Histoplasmosis hepatitis after orthotopic liver transplantation

Washburn

Galván

Dhingra

et al. 2017

Journal of Surgical Case Reports

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Histoplasmosis is an endemic mycosis in the Ohio and Mississippi River valleys and can cause disseminated infection in immunocompromised hosts. Disseminated histoplasmosis is often respiratory in nature and most cases in transplant patients occur within 2 years post-transplantation. A 32-year-old male on mycophenolate and tacrolimus who underwent an orthotopic liver transplantation 10 years prior presented with generalized body aches, fevers, mild congestion, dysuria and elevated transaminases. Liver biopsy revealed epithelioid granulomas with narrow-based budding yeast, suggesting histoplasma. Liver involvement in disseminated histoplasmosis is well characterized however the disease is usually pulmonary in origin. Only three other case reports describe isolated granulomatous hepatitis, and this is the first to our knowledge to occur in a liver transplant allograft. A high index of suspicion is essential for diagnosis and prompt treatment of histoplasmosis in transplant patients considering their immunocompromised state.

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“…The retrospective design of our cohort was restricted to only adenocarcinomas and granulomas and currently mimics the high possibility of a real clinical dilemma, especially in the Ohio River Valley or the upper Midwest region of the United States (32,33). Further work is neededto focus on incorporating other benign and malignant nodules into the classifier and validating it on a larger multisite data set.…”

Section: Discussionmentioning

confidence: 99%

Perinodular and Intranodular Radiomic Features on Lung CT Images Distinguish Adenocarcinomas from Granulomas

et al. 2019

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Purpose: To evaluate ability of radiomic (computer-extracted imaging) features to distinguish non-small cell lung cancer adenocarcinomas from granulomas at noncontrast CT. Materials and Methods: For this retrospective study, screening or standard diagnostic noncontrast CT images were collected for 290 patients (mean age, 68 years; range, 18–92 years; 125 men [mean age, 67 years; range, 18–90 years] and 165 women [mean age, 68 years; range, 33–92 years]) from two institutions between 2007 and 2013. Histopathologic analysis was available for one nodule per patient. Corresponding nodule of interest was identified on CT axial images by a radiologist with manually annotation. Nodule shape, wavelet (Gabor), and texture-based (Haralick and Laws energy) features were extracted from intra- and perinodular regions. Features were pruned to train machine learning classifiers with 145 patients. In a test set of 145 patients, classifier results were compared against a convolutional neural network (CNN) and diagnostic readings of two radiologists. Results: Support vector machine classifier with intranodular radiomic features achieved an area under the receiver operating characteristic curve (AUC) of 0.75 on the test set. Combining radiomics of intranodular with perinodular regions improved the AUC to 0.80. On the same test set, CNN resulted in an AUC of 0.76. Radiologist readers achieved AUCs of 0.61 and 0.60, respectively. Conclusion: Radiomic features from intranodular and perinodular regions of nodules can distinguish non-small cell lung cancer adenocarcinomas from benign granulomas at noncontrast CT. Summary Perinodular and intranodular radiomic features corresponding to texture and shape (radiomics) were evaluated to distinguish nonsmall cell lung cancer adenocarcinomas from benign granulomas at noncontrast CT.

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

Cited by 17 publications

References 10 publications

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Histoplasmosis hepatitis after orthotopic liver transplantation

Perinodular and Intranodular Radiomic Features on Lung CT Images Distinguish Adenocarcinomas from Granulomas

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