Acute Liver Failure and Fever of Unknown Origin

Abstract

We describe a case of acute liver failure in a woman in whom a diagnosis was initially unable to be established. The patient rapidly deteriorated, requiring admission to the intensive care unit, and was placed under consideration for liver transplantation. On consultation with the infectious disease service, thorough history taking was performed that uncovered salient epidemiologic information pointing toward the eventual diagnosis of disseminated histoplasmosis. We discuss aspects of diagnosis and management, including the management of immune reconstitution syndrome which complicated treatment.

Keywords: TNF-α inhibitor; histoplasmosis; immune deficiency; immune reconstitution syndrome.

Figure 1.

Contrast-enhanced computed tomography scan of the abdomen and pelvis. Numerous hypointense splenic lesions with associated splenomegaly.

Figure 2.

Grocott methenamine silver–stained liver biopsy specimen, 200× magnification. Multiple Histoplasma yeast forms are present (arrow).

Figure 3.

Grocott methenamine silver–stained liver biopsy specimen, 400× magnification. Multiple Histoplasma yeast forms are present (arrow).