SHM Converge Scientific Abstract ePoster Gallery-Histoplasma Colitis in a Transplant Patient

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This case highlights a rare but important cause of colitis in immunocompromised patients: gastrointestinal histoplasmosis, specifically Histoplasma colitis in a kidney transplant recipient. Symptomatic GI involvement occurs in only 3–12% of disseminated histoplasmosis cases, though autopsy studies suggest the organism may be present in the GI tract much more often.<br /><br />The patient was in their 30s with a history of ESRD from membranous nephropathy, kidney transplant in 2022, hypertension, and antiphospholipid antibody syndrome. They had previously tested positive for Histoplasma urine antigen and had Histoplasma identified on renal biopsy, but were treated only with a short course of itraconazole. They later presented with abdominal pain, fevers, chills, nausea, vomiting, and diarrhea.<br /><br />Workup showed diffuse colitis on CT scan and discontinuous, non-bleeding ulcerations on colonoscopy. Biopsy revealed narrow-based budding yeast on GMS stain, consistent with Histoplasma capsulatum, with no granulomas seen. Histoplasma urine and serum antigens were positive. Imaging showed no CNS or pulmonary involvement, and fungal blood cultures were negative.<br /><br />During hospitalization, the patient continued to have severe abdominal pain, diarrhea, poor oral intake, fevers, leukocytosis, and later hematochezia. Treatment with itraconazole led to clinical improvement, and tacrolimus dosing had to be significantly reduced due to drug interaction.<br /><br />The report emphasizes that histoplasma colitis often presents with diarrhea, abdominal pain, and weight loss, while bloody diarrhea is less common. Diagnosis requires a high index of suspicion and biopsy with special stains such as GMS or PAS. In transplant patients with colitis and a history of histoplasmosis, early endoscopy should be considered. Prolonged or even lifelong antifungal therapy may be needed in patients at high risk for reinfection.

Asset Subtitle

Julia Hughes

Meta Tag

Author List Brett Martin, Farzana Hoque, Julia Hughes

Category Clinical Vignettes

Concept Histoplasma Colitis

Concept Disseminated Histoplasmosis

Concept Gastrointestinal Histoplasmosis

Concept Tissue Biopsy

Concept Amphotericin B

Distinguished Non-Finalist

Presenter Organization Saint Louis University School of Medicine - - Saint Louis, MO

Presenting Author Julia Hughes

Track Adult

Keywords

Histoplasma colitis

gastrointestinal histoplasmosis

kidney transplant recipient

immunocompromised colitis

disseminated histoplasmosis

itraconazole treatment

colonoscopy biopsy

GMS stain

tacrolimus interaction

Histoplasma capsulatum

Histoplasma Colitis

Disseminated Histoplasmosis

Gastrointestinal Histoplasmosis

Tissue Biopsy

Amphotericin B