Abstract: TH-PO583
A Case of Biopsy Proven Histoplasmosis in a Renal Allograft
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Malik, Anum, Cleveland Clinic, Beachwood, Ohio, United States
- Zaky, Ziad S., Cleveland Clinic, Beachwood, Ohio, United States
- Mehdi, Ali, Cleveland Clinic, Beachwood, Ohio, United States
Introduction
Fungal infections in immunocompromised hosts are well described. However, histoplasma capsulatum is not known to directly infect the allograft in kidney transplant (KT) patients. We report a case of disseminated histoplasmosis infecting the renal allograft.
Case Description
A 52 year old male with ESRD from IgA nephropathy, status post deceased donor KT in 2007, presented in 2017 with constitutional symptoms, dry cough and AKI for 3 weeks. His transplant course was complicated by an early Banff 1A rejection and was maintained on tacrolimus (FK), mycophenolate (MMF) & prednisone. Of note, he had recently been renovating a house in southern Ohio. CT chest & abdomen showed bilateral lung opacities, mediastinal/hilar lymphadenopathy & perinephric fat stranding around the allograft. Due to the unexplained AKI, a renal biopsy was done, showing focal granulomatous interstitial inflammation with silver positive organisms and glomerulitis with macrophages containing histoplasma. A transbronchial lung biopsy confirmed granulomatous pneumonia with histoplasma, meeting criteria for disseminated histoplasmosis. Histoplasma urinary antigen also resulted positive later. He was discharged on itraconazole and MMF was held. He was re-admitted a week later with diffuse morbiliform rash concerning for cutaneous histoplasmosis, but skin biopsy was consistent with drug reaction. Due to amphotericin B intolerance, he was switched to oral fluconazole, with a goal of 12 months treatment. At 3, 6 & 9 months follow up, he continued to do well with his creatinine stabilizing at baseline. His MMF was resumed after 6 months of antifungal treatment.
Discussion
We present a unique case of a biopsy proven disseminated histoplasmosis involving renal allograft in a KT patient who has done well with treatment. Our case underscores the importance of a broad differential and thorough history when evaluating immunocompromised patients.
GMS stain showing both yeast and hyphae in the interstitium, consistent with histoplasmosis.