Abstract: FR-PO1034
Isavuconazonium for Disseminated Histoplasmosis in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Teran, Federico Jose, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Widmer, Kyle, Tulane University School of Medicine, New Orleans, Louisiana, United States
Introduction
Histoplasmosis infection is rare in kidney transplant patients with disseminated disease being a major cause of morbidity and mortality and graft loss. Treatment for disseminated disease is limited but, new triazoles, such as Isavuconazonium, have been reported as therapeutic options. Here is a case of disseminated histoplasmosis in a kidney transplant patient treated with Isavuconazonium, allowing for a re-transplant.
Case Description
A veteran with a stable cadaveric kidney for 14 years, was hospitalized for fever of unknown origin, diarrhea, and acute kidney injury a year after starting a job as a truck driver hauling chickens. Chest CT showed 9 mm peri bronchial spiculated nodular density, urinary histoplasma antigen was 2.6 ng/ml (nl <0.5 ng/ml), and bronchoscopy confirmed histoplasmosis. He improved with itraconazole but had inconsistent therapeutic levels due to absorption. Repeated relapses of histoplasmosis led to development of overwhelming disseminated disease, sepsis, AKI with eventual graft loss. He was treated with Amphotericin B, reduction of immunosuppression, and transitioned back to itraconazole. He developed prolonged QTc on itraconazole, so his dose was reduced. Colonoscopy preparing for kidney re-transplantation showed invasive Histoplasmosis. He was switched to isavuconazonium, and repeat colonoscopy was clear. He was re-transplanted and remains on prophylactic isavuconazonium with a creatinine of 1.2 -1.5 mg/dl.
Discussion
This patient was treated with itraconazole but compliance, absorption limitations, and side effects attenuated therapeutic success. Isavuconazonium was tolerated better which improved compliance, cleared the infection, and allowed for him to be re-transplanted. More research is needed but isavuconazonium may be a potential therapeutic option for treatment of histoplasmosis in kidney transplant patients.