1. Histoplasma capsulatum presenting as generalized lymphadenopathy after renal transplantation
- Author
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Sujit Vijay Sakpal, Robert N. Santella, Hector Saucedo-Crespo, Jeffrey Steers, Jawad Nazir, Christopher Auvenshine, and Tej I Mehta
- Subjects
0301 basic medicine ,Fungal infection ,medicine.medical_specialty ,Itraconazole ,030106 microbiology ,Histoplasma ,IDSA, Infectious Disease Society of America ,PTH, post-transplant histoplasmosis ,Disease ,Infectious and parasitic diseases ,RC109-216 ,Transplant ,Histoplasmosis ,Article ,PET, positron emission tomography ,03 medical and health sciences ,0302 clinical medicine ,IFI, invasive fungal infection ,medicine ,Decompensation ,030212 general & internal medicine ,Infectious disease ,Leukopenia ,biology ,business.industry ,SOT, solid organ transplant ,medicine.disease ,biology.organism_classification ,Dermatology ,post-op, post-operative ,CT, computed tomography ,Transplantation ,Infectious Diseases ,medicine.symptom ,business ,Generalized lymphadenopathy ,medicine.drug - Abstract
Histoplasma capsulatum is typically an indolent disease among immunocompetent patients. However, immunocompromised patients, such as solid organ transplant recipients, are at risk of developing severe histoplasmosis. Yet post-transplant histoplasmosis is a rare pathology, representing less than five percent of invasive fungal infections among transplant recipients. Furthermore, patients tend to present with nonspecific clinical symptoms, complicating timely diagnosis and delaying treatment. Disease features that may be more representative of H. capsulatum infection, such as anemia, leukopenia and pulmonary involvement are often not present until late in the disease course, when the patient is at greater risk of decompensation. Unlike H. capsulatum infections among immunocompetent hosts, extrapulmonary infection among immunocompromised hosts is more the rule than the exception. Treatment with liposomal amphotericin B followed by oral itraconazole is the standard therapy, but special considerations must be made for patients with hepatic and/or renal insufficiency, underlying cardiac abnormalities or malabsorptive pathologies and doses of immunosuppressants will need to be adjusted for drug interactions. Herein we present a case of H. capsulatum infection presenting with generalized lymphadenopathy post-renal transplant. Keywords: Infectious disease, Histoplasma, Transplant, Fungal infection
- Published
- 2020