SHM Converge Scientific Abstract ePoster Gallery-Unusual Histoplasmosis in an Immunosuppressed Traveler

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This case report describes an unusual presentation of disseminated histoplasmosis in a 50-year-old immunosuppressed kidney transplant recipient. The patient had ESRD from diabetes, received a deceased-donor renal transplant in 2018, and was taking tacrolimus, mycophenolate mofetil, and prednisone. He presented after 10 days of fever, headache, neck stiffness, nausea, and vomiting, and had already made several emergency visits where he was treated empirically for possible sinusitis without improvement.<br /><br />Initial evaluation focused on a possible CNS infection. Head, abdominal, and pelvic CT scans, lumbar puncture studies, urinalysis, and blood cultures were unrevealing. He was started on broad-spectrum antibiotics, but symptoms persisted. Chest imaging later revealed multifocal bilateral airspace opacities, and the patient subsequently developed transaminitis, oral ulcerations, and acute hypoxic respiratory failure. Because of the worsening pulmonary findings, bronchoscopy and fungal testing were obtained. Transbronchial biopsy and a positive Histoplasma urine antigen confirmed histoplasmosis, presumed disseminated.<br /><br />Treatment was changed from antibiotics to amphotericin B followed by itraconazole, with progressive clinical improvement. He was discharged six days later on itraconazole.<br /><br />The report emphasizes that Histoplasma capsulatum, a dimorphic fungus endemic in parts of the United States, usually causes pulmonary disease after inhalation, but immunocompromised patients are at high risk for disseminated infection. This case was notable because the patient had no respiratory symptoms at presentation, delaying diagnosis and initially directing care toward CNS infection. The authors stress that in immunosuppressed patients with unexplained fever, especially those with travel to endemic regions, disseminated histoplasmosis should be considered early.

Asset Subtitle

Parker Foster

Meta Tag

Author List Moiz Ansari, Parker Foster, Pinky Jha, Taylor Craig, Yasir Abdelgadir

Category Clinical Vignettes

Concept Histoplasmosis

Concept Disseminated Histoplasmosis

Concept Immunosuppression

Concept Urinary Antigen Test

Concept Amphotericin B

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Parker Foster

Track Adult

Keywords

disseminated histoplasmosis

kidney transplant recipient

immunosuppressed patient

Histoplasma capsulatum

fungal infection

central nervous system infection

amphotericin B

itraconazole

pulmonary opacities

Histoplasma urine antigen

Histoplasmosis

Disseminated Histoplasmosis

Immunosuppression

Urinary Antigen Test

Amphotericin B