Increasing Alkaline Phosphatase as the Primary Manifestation of Disseminated Histoplasmosis in an AIDS Patient Without Pulmonary Disease

Histoplasmosis is an infection caused by the dimorphic fungi Histoplasma. Hepatic involvement in the setting of disseminated histoplasmosis from a pulmonary source is well documented. Hepatic involvement as the primary manifestation in the absence of pulmonary disease is rare. We present a patient with acquired immune deficiency syndrome found to have disseminated histoplasmosis with worsening alkaline phosphatase as the primary manifestation of disease, which has not been reported in a review of the literature. After diagnosis, the patient was started on appropriate therapy with alkaline phosphatase return to baseline.