SHM Converge Scientific Abstract ePoster Gallery-Atypical Presentation of CNS Histoplasmosis & Blastomycosis in Transplant Recipient

Pdf Summary

This case report describes an atypical central nervous system (CNS) fungal infection in a 23-year-old man with a kidney transplant 10 years earlier. He presented with diffuse headaches and photophobia. Although his initial brain MRI was normal, cerebrospinal fluid (CSF) studies were abnormal. A repeat lumbar puncture later became positive for Histoplasma, and he was treated with intravenous amphotericin B and voriconazole. Follow-up MRI then showed multifocal leptomeningeal enhancement consistent with meningitis.<br /><br />The case was diagnostically challenging because several initial tests were negative, including a meningitis/encephalitis panel, fungal cultures, and urine Histoplasma/Blastomyces antigen testing. A chest CT showed clustered nodularity in the left lower lobe, but bronchoalveolar lavage did not reveal fungal infection. Later, Blastomyces antigen and antibody tests became positive, so antifungal therapy was continued. Oral therapy was maintained after discharge, with later switch from voriconazole to itraconazole because of elevated liver enzymes.<br /><br />The discussion emphasizes that kidney transplant recipients have increased risk for Histoplasma and Blastomyces infection, but these infections remain uncommon overall. Geographic exposure to endemic areas such as the Mississippi and Ohio River valleys is a major risk factor. Histoplasmosis may occur either soon after transplant or years later, which fits this patient’s presentation 10 years post-transplant. Diagnosis can be difficult, especially in CNS disease, because symptoms may be nonspecific and pulmonary findings may be absent. Fungal culture remains the standard diagnostic method, but sensitivity is limited in CNS cases.<br /><br />The report concludes that clinicians should consider endemic fungal infections in transplant patients with unexplained neurologic symptoms, especially when they live in or have exposure to endemic regions. Long-term antifungal treatment and close monitoring of drug levels and liver function are essential.

Asset Subtitle

Saundra Manyitabot

Meta Tag

Author List Caidon Iwuagwu, Roshan Thapa, Ruturaj Vala, Saundra Manyitabot

Category Clinical Vignettes

Concept CNS Histoplasmosis

Concept Blastomycosis

Concept Solid Organ Transplant Recipient

Concept Amphotericin B

Concept Endemic Geographic Exposure

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Saundra Manyitabot

Track Adult

Keywords

central nervous system infection

fungal meningitis

kidney transplant

Histoplasma

Blastomyces

leptomeningeal enhancement

cerebrospinal fluid

amphotericin B

voriconazole

endemic fungal infection

CNS Histoplasmosis

Blastomycosis

Solid Organ Transplant Recipient

Amphotericin B

Endemic Geographic Exposure