Miliary Histoplasmosis in a Renal Transplant Patient (original) (raw)
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Disseminated histoplasmosis in a kidney transplant patient
Nefrologia, 2008
Patients with impaired cell-mediated immunity have a higher risk of developing histoplasmosis; however, histoplasmosis after solid organ transplantation is rare. In Thailand, histoplasmosis cases are sporadic, and most cases are associated with human immunodeficiency virus (HIV) infection. Herein, we report a case of disseminated histoplasmosis in a kidney transplant Thai recipient diagnosed by fungal staining of fungal culture from bronchoalveolar lavage and bone marrow biopsy. Liposomal amphotericin B was given followed by oral itraconazole. The patient's clinical condition was improved; however, his graft function was irreversibly declined. The majority of histoplasmosis cases after solid organ transplant presented with disseminated disease with pulmonary involvement. Even in a non-endemic area of histoplasmosis, suspected cases should be early diagnosed and promptly managed in order to reduce morbidity and mortality, especially in cellmediated immunity defect patients like solid organ transplant recipients.
Sepsis-like histoplasmosis in a kidney transplant patient
Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia, 2018
Histoplasmosis is a fungus infection that mainly affects immunosuppressed patients. The authors present a case of a kidney transplant recipient who developed sepsis-like histoplasmosis, na atypical but severe manifestation of the disease. The fungus was found in blood and in a skin biopsy, and the treatment with liposomal amphotericin resulted in hepatotoxicity.
Transplant Infectious Disease, 2002
Questions have arisen regarding the risk of developing symptomatic Histoplasma capsulatum infection among patients who undergo transplant-related immunosuppression in areas endemic for histoplasmosis. Our medical center is located in a hyperendemic area for histoplasmosis, where three large outbreaks occurred since 1978. We undertook a retrospective chart review of 137 patients who received allogeneic bone marrow transplant and of 449 patients who received solid organ transplant from January 1994 to December 1996 in order to assess the incidence of active histoplasmosis. Charts were reviewed before and after transplantation for clinical outcomes, H. capsulatum serologies and antigen results, and microbiological and radiological results. After a mean follow-up duration exceeding 16 months, no patient was diagnosed with histoplasmosis. In the absence of an outbreak, histoplasmosis is a rare infection following the immunosuppression of allogeneic bone marrow or solid organ transplantation even in a hyperendemic area. Pre-transplant serologies or chest radiographs consistent with prior infection were not associated with post-transplant histoplasmosis. Histoplasmosis is a cause for morbidity and mortality in both allogeneic bone marrow and solid organ transplantation, though its exact incidence and mode of acquisition among these groups remain unknown. In immunosuppressed patients, histoplasmosis behaves as an opportunistic infection, manifested by progressive disseminated disease, rather than the self-limited pulmonary infection typically experienced by immunocompetent patients (1). Histoplasmosis typically is initiated by inhalation of Histoplasma capsulatum spores when environmental sites, contaminated with the organism, are disturbed. However, reactivation of latent foci of past infection by immunosuppression has been proposed as the mode of acquisition following transplantation. Davies et al. reported five cases among 1300 renal transplant recipients during a 4-year period, which they attributed to reactivation of latent infection by the immunosuppression administered in order to prevent or treat rejection (2).
Fulminant sepsis due to disseminated histoplasmosis in renal transplantation: A diagnostic challenge
Journal of Acute Medicine, 2012
Disseminated histoplasmosis can be extremely life threatening if not identified and treated promptly. Diagnosing fungal infections in patients receiving solid organ transplants and in those who are immunosuppressed is pivotal in prevention of fungal sepsis. These patients may present with subtle chronic symptoms prior to sepsis. The patient, a 77-year-old woman who had a kidney transplant from a living related donor about 26 years previously, presented with recurrent skin rash and muscle weakness for 4 months. Her skin biopsy showed nonspecific granulomas prior to admission. On presentation she remained critically ill, and her radiographic imaging or cultures did not show specific abnormalities throughout the disease course, except for a positive urine histoplasma antigen and serum histoplasma polymerase chain reaction. Her clinical status deteriorated eventually leading to death. This case highlights the importance of rapid diagnostic tests in the early diagnosis of disseminated histoplasmosis, which could potentially prevent fulminant sepsis.
Transplant Infectious Disease, 2013
Initial presentation of invasive fungal infections such as histoplasmosis can include non-specific clinical manifestations, especially in immunocompromised patients. A high index of suspicion is required to identify atypical manifestations of these diseases, which carry a high risk of mortality, if the diagnosis is delayed or missed. We describe a case of a kidney transplant recipient with cutaneous lesions as initial manifestation of progressive disseminated histoplasmosis where a skin biopsy was crucial to an early diagnosis.
BMJ case reports, 2017
A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy. Work-up revealed bilateral adrenal masses, biopsy showed granulomatous changes consistent with histoplasmosis. The possibility of histoplasmosis was less likely as the patient had no prior history of symptomatic disease and had lived in the endemic area 30 years prior to presentation. Brain biopsy confirmed central nervous system involvement. Amphotericin B was initiated for disseminated disease but his hospital course was complicated by renal failure and new liver hypodensities on follow-up imaging. Acute progressive disseminated histoplasmosis can manifest after decades of initial exposure and should always be in differential diagnosis even in non-endemic areas for prompt diagnosis and better clinical outcome.
Gastrointestinal presentation of disseminated histoplasmosis in a transplant recipient
Histoplasmosis is a clinically relevant fungal infection in immunosuppressed patients, in whom it may present as a serious disease. We describe the case of a renal transplant recipient who presented with malaise, dry cough, severe weight loss, abdominal pain and watery diarrhoea. The laboratory workup revealed anaemia and elevated C reactive protein. Chest X-ray showed bilateral reticulonodular infiltrates, and computed tomography scan of the chest and abdomen revealed diffuse thickening of the inter-and intralobular septs, suggestive of lymphangitic infiltration. The abdomen had multiple lymphadenopathies along the mesenteric vessels. Endoscopic evaluation disclosed disseminated ulcers throughout the entire gastrointestinal tract, and biopsies confirmed the diagnosis of histoplasmosis. Despite adequate treatment with liposomal amphotericin B, the patient had a fatal outcome. We describe this case because of the rarity of gastrointestinal presentation in the context of disseminated histoplasmosis, and we also speculate about the transmission through the allograft. It highlights the importance of considering this once geographically limited disease in challenging cases, even in non-endemic areas.
Belatacept and mediastinal histoplasmosis in a kidney transplant patient
Journal of Nephropathology, 2016
In kidney transplantation, there is an increased risk of infections. Belatacept is a novel and effective immunosuppressant with no nephrotoxic effects. We describe the first reported patient on belatacept therapy with an opportunistic infection due to Histoplasma capsulatum.