Isolated hepatic histoplasmosis in an immunocompetent patient

Isolated involvement of the liver in histoplasmosis is rare. We report a case of an immunocompetent patient in their mid-40s who presented with prolonged fever and elevated liver enzymes. Liver biopsy revealed granulomas, and histoplasmosis was confirmed by Periodic Acid-Schiff staining and positive urinary Histoplasma antigen test. No other organ involvement was found. Treatment with Amphotericin B and Itraconazole resulted in complete recovery, and Urinary Histoplasma antigen was negative 6 weeks after treatment initiation. This report highlights the importance of considering histoplasmosis in cases of unexplained hepatic dysfunction, even in immunocompetent patients. Also, the rare presentation of histoplasmosis with isolated hepatic involvement is discussed. This case adds to the growing body of evidence on histoplasmosis in India, a region traditionally considered non-endemic for the disease.