Abstract: SA-PO1153
A Perfect Storm: Disseminated Histoplasmosis in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Saleem, Ibrahim, The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
- Madrigal, Andres G., The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
- Ali, Muhammad Usman, The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
- Saleem, Adam, SUNY Upstate Medical University, Syracuse, New York, United States
Introduction
Kidney Transplantation offers superior long-term renal function but necessitates lifelong immunosuppression. Contemporary regimens combining calcineurin inhibitors/antimetabolites elevate opportunistic infection risk. Disseminated histoplasmosis manifests with fever, dyspnea, and hepatosplenomegaly confirmed through culture or urinary antigen detection. While rare in transplant recipients overall (<1%), histoplasmosis exhibits pronounced geographic predilection in endemic zones—notably the Ohio and Mississippi River Valleys—where Histoplasma capsulatum spores persist in soil. Disseminated disease typically develops 6-12 months post-transplant in patients, making recognition essential for those in endemic regions.
Case Description
A 57-year-old male presented in February 2026, two months post-renal transplantation, with progressive dyspnea and fever (103.1°F). Initial evaluation revealed pulmonary embolism, leading to acute hypoxic respiratory failure requiring mechanical ventilation. Rapid deterioration in mental status raised concern for opportunistic infection. Peripheral blood smear demonstrated intracellular yeasts consistent with Histoplasma capsulatum, enabling prompt initiation of empiric Amphotericin B. Furthermore, there was GMS Positive Yeast detected in the Bone Marrow, suggestive of Bone Marrow Mycosis. Patient was noted to have worsened acute kidney injury necessitating renal replacement therapy with subsequent improvement in hemodynamic instability and kidney function. The patient was successfully extubated after 6 days and renal function stabilized after 2-3 weeks. He was discharged home after 32 days on long-term oral Posaconazole prophylaxis.
Discussion
Disseminated Histoplasmosis represents a critical fulminant fungal threat in immunosuppressed transplant patients. This case exemplifies the value of diagnostic vigilance in early post-transplant patients. Peripheral blood morphology revealing intracellular yeasts enabled immediate Amphotericin B therapy ahead of confirmatory testing. Immunosuppressive regimens create vulnerability to severe fungal pathogens. This case demonstrates that astute microscopy combined with aggressive therapy transforms a catastrophic diagnosis into survival, reinforcing our obligation to anticipate opportunistic infections in transplant stewardship.