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Kidney Week

Abstract: PO1950

Disseminated Histoplasmosis Mimicking Crohn Disease in Kidney Transplant Recipient

Session Information

Category: Pathology and Lab Medicine

  • 1600 Pathology and Lab Medicine

Authors

  • Gomez Johnson, Victor Hugo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, ciudad de Mexico, Mexico
  • Martinez-Vazquez, Belen, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, ciudad de Mexico, Mexico
  • Garcia-Flores, Octavio Rene, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, ciudad de Mexico, Mexico
  • Rodríguez, Francisco, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, ciudad de Mexico, Mexico
Introduction

Fungal infections can occur after a kidney transplant due to the use of immunosuppressants. Histoplasmosis is an endemic infection in Mexico and it’s pulmonary phase is very common. The risk of complications is high, so an early diagnosis should ideally be made with a biopsy of the affected tissue. We report the case of a kidney transplant recipient with chronic diarrhea associated with disseminated histoplasmosis simulating Chron's disease.

Case Description

A 50-year-old woman with history of CKD of unknown etiology underwent living donor kidney transplant. She received induction with basiliximab and maintenance therapy based on azathioprine, prednisone and cyclosporine. Six years after transplantation, the calcineurin inhibitor was discontinued due to toxicity documented by biopsy and continued with Sirolimus and mycophenolate mofetil. One year after transplantation, she was evaluated for fever and pulmonary nodules, without detecting infectious etiology. One year later, she presented diarrhea and based on the presence of colonic ulcers, Chron's disease was suspected and treatment with mesalazine was started. Due to the persistence of diarrhea, a second colonoscopy was performed establishing the diagnosis of histoplasmosis by means of biopsies of the colonic mucosa and with urinary antigen. Amphotericin B treatment was initiated and 2 weeks later urinary antigen was negative and renal function returned to baseline. Itraconazole-based maintenance therapy was chosen.

Discussion

Acute pulmonary histoplasmosis is caused by inhaling spores and it tends to be a self-limited disease. Disseminated histoplasmosis is common in immunocompromised patients. Gastrointestinal involvement is clinically manifested in 20% of cases, although urinary antigen has a 95% specificity, histopathological identification with PAS(+) and Giemsa(-) stains, remains the ideal test, as they showed submucosal and lamina propia macrophage invasion at the intestinal tissue. Chronic diarrhea can be a manifestation of systemic fungal infection in kidney transplant recipients.