SHM Converge Scientific Abstract ePoster Gallery-Miliary Nodules in a Post-Kidney Transplant Patient: Fungus or Tuberculosis?

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This poster describes a 33-year-old woman with a recent kidney transplant and type 1 diabetes who presented with fever, chills, mild headache, photophobia, dry cough, fatigue, and night sweats. She had recently moved from Tennessee to Florida. Because of her immunosuppressed status, the team initially treated her broadly for possible bacterial, viral, and neurologic infection, but CT head, brain MRI, and lumbar puncture ruled out CNS involvement.<br /><br />A chest CT showed diffuse miliary nodules throughout both lungs and focal lingular consolidation, raising concern for a hematogenous infection such as tuberculosis or fungal disease. The patient was started on liposomal amphotericin B and empiric antitubercular therapy. Although beta-D-glucan was indeterminate, urine Histoplasma antigen was positive, and next-generation sequencing further supported histoplasmosis. After a negative QuantiFERON test, tuberculosis treatment was stopped. Following one week of amphotericin B, she was transitioned to itraconazole and improved clinically before discharge, with continued therapy planned for 6–12 weeks.<br /><br />The poster highlights that Histoplasma is a dimorphic fungus endemic to the Ohio and Mississippi River valleys, acquired by inhalation of spores, and is more common and more severe in immunosuppressed patients, including renal transplant recipients. Clinical features are often nonspecific and may include persistent fever, weight loss, pancytopenia, pulmonary infiltrates, and extrapulmonary involvement of organs such as the liver, spleen, bone marrow, CNS, and GI tract.<br /><br />Diagnosis is supported by Histoplasma antigen testing in urine, serum, BAL, or CSF, with fungal cultures as the gold standard and molecular methods as additional tools. Early recognition and treatment are emphasized to prevent serious complications and reduce mortality in transplant patients.

Asset Subtitle

Ashirbad Acharya

Meta Tag

Author List Anshumala Adhikari, Ashirbad Acharya, Jagdish Sharma, Ranjit Sapkota, Shanti Sharma, Shristi Nepal

Category Clinical Vignettes

Concept Histoplasmosis

Concept Rapid Antigen Test

Concept Urinary Antigen Test

Concept Liposomal Amphotericin B

Concept Itraconazole

Distinguished Non-Finalist

Presenter Organization AdventHealth Orlando

Presenting Author Ashirbad Acharya

Track Adult

Keywords

Histoplasmosis

Kidney transplant

Immunosuppressed patient

Miliary nodules

Liposomal amphotericin B

Itraconazole

Urine Histoplasma antigen

Dimorphic fungus

Pulmonary infection

Renal transplant recipient

Histoplasmosis

Rapid Antigen Test

Urinary Antigen Test

Liposomal Amphotericin B

Itraconazole