SHM Converge Scientific Abstract ePoster Gallery-Uncommon Presentation of Histoplasmosis in a Kidney Transplant Recipient: Failure to Recognize Disseminated Disease With Persistent Oral Ulcers as the Initial Symptom

Uncommon Presentation of Histoplasmosis in a Kidney Transplant Recipient: Failure to Recognize Disseminated Disease With Persistent Oral Ulcers as the Initial Symptom

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This case describes disseminated histoplasmosis in a 48-year-old kidney transplant recipient with chronic immunosuppression and lymphopenia. He presented with an eight-month history of oral pain, odynophagia, major weight loss, and progressive ankle pain. Exam showed tongue plaques and shallow ulcers, while initial treatment for candidiasis failed. Infectious workup for HIV, CMV, EBV, and BK virus was negative. A tongue biopsy later revealed intracellular fungal organisms consistent with <em>Histoplasma capsulatum</em>, and urine Histoplasma antigen was positive.

Further evaluation showed a calcified lung granuloma, bilateral adrenal nodules, and tenosynovitis in the ankle and knee on imaging, supporting disseminated disease. He was treated with posaconazole, mycophenolate was stopped, and prednisone was continued for adrenal replacement. His condition improved and urine antigen levels decreased by 50%, though he later developed new tenosynovitis in the opposite knee, possibly related to immune reconstitution after immunosuppression reduction.

The report emphasizes that histoplasmosis in immunocompromised patients may present with unusual, nonspecific findings such as oral ulcers and tenosynovitis, which can delay diagnosis. It highlights the importance of early histopathologic evaluation and broad clinical suspicion for disseminated fungal infection in transplant recipients to allow prompt treatment and prevent progression.

Asset Subtitle

Claudia Natalie Aragon Flores

Meta Tag

Author List Claudia Natalie Aragon Flores, Laura Shevy, Pooja Singh, Ulises Rodriguez Medina

Category Clinical Vignettes

Concept Disseminated Histoplasmosis

Concept Immunocompromised State

Concept Antifungal Therapy

Concept Renal Transplant Recipient

Concept Extrapulmonary Manifestation

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Claudia Natalie Aragon Flores

Track Adult

Keywords

disseminated histoplasmosis

kidney transplant recipient

immunosuppression

lymphopenia

oral ulcers

tongue biopsy

Histoplasma capsulatum

urine Histoplasma antigen

tenosynovitis

fungal infection

Disseminated Histoplasmosis

Immunocompromised State

Antifungal Therapy

Renal Transplant Recipient

Extrapulmonary Manifestation