Abstract: SA-PO1012
A Rare Case of Disseminated Coccidioidomycosis in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Ahmed, Taha, Houston Methodist Hospital, Houston, Texas, United States
- Ayah, Omar A., Houston Methodist Hospital, Houston, Texas, United States
- Michael, Mark Atef, Cairo University, Giza, Giza Governorate, Egypt
- Gaber, Lillian W., Houston Methodist Hospital, Houston, Texas, United States
- Grimes, Kevin Anthony, Houston Methodist Hospital, Houston, Texas, United States
Introduction
Coccidioidomycosis (Valley fever) is a fungal infection endemic to the Western hemisphere, specifically to Southwestern United States and Central/South America. Coccidioidomycosis primarily manifests as a respiratory infection through inhalation of airborne arthroconidia (spores). Extrapulmonary manifestations occur through hematogenous and lymphatic spread, manifesting as osteomyelitis, lymphadenitis, meningitis, soft tissue and cutaneous infections or in the urogenital system. We present a case of renal coccidioidomycosis in a kidney transplant recipient.
Case Description
A 46-year-old male with a history of simultaneous kidney and pancreas transplant at age 29 was admitted for COVID-19 pneumonia, complicated by ARDS. While recovering, chest x-ray showed new-onset diffuse cavitary lesions. CT Chest showed diffuse miliary micronodules and multifocal cavitary lesions. Bronchoscopy confirmed Coccidioidomycosis, which was treated with fluconazole. Six months later, he developed worsening renal function, with serum creatinine (Scr) rising from a baseline of 1.1mg/dL to 1.5. Renal allograft biopsy showed fungal granulomatous interstitial nephritis. Grocott's methenamine silver stain confirmed Coccidioidomycosis. He was treated with a 14-week course of amphotericin B, followed by lifelong treatment with fluconazole (due to his immunocompromised state). His maintenance immunosuppression regimen includes tacrolimus, mycophenolate mofetil and low dose prednisone. His renal function has stabilized at a baseline Scr of 1.4mg/dL.
Discussion
This case demonstrates the importance of considering fungal infections in immunocompromised patients in the differential for AKI. Our patient's immune system was doubly compromised by his immunosuppressive medications and his COVID-19 infection.
Grocott's methenamine silver stain showing fungal structures within the cavity, morphology consistent with Coccidioidomycosis.