Inflammatory Hilar Mass and Cavernous Transformation in Disseminated Histoplasmosis: A Rare Cause of Noncirrhotic Portal Hypertension.

Disseminated histoplasmosis is a fungal infection usually encountered in immunocompromised hosts. Hepatic involvement is common, but portal hypertension due to extrahepatic lymph node compression has not been described. We present a 68-year-old man without cirrhosis who developed noncirrhotic portal hypertension by reactive, fibrosing porta hepatis lymphadenopathy after disseminated histoplasmosis treatment. Despite prior exposure to immunosuppressive therapy for presumed sarcoidosis, liver biopsy demonstrated preserved hepatic architecture and normal hepatic venous pressure gradient, supporting a presinusoidal, extrahepatic mechanism. This case highlights a novel, compressive cause of noncirrhotic portal hypertension and underscores the importance of recognizing immune reconstitution inflammatory responses in disseminated histoplasmosis.