Cutaneous and Bone Marrow Histoplasmosis After 18 Years of Renal Allograft Transplant

The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to...

Full description

Saved in:

Bibliographic Details
Published in:	Mycopathologia (1975) Vol. 178; no. 3-4; pp. 273 - 278
Main Authors:	Ibrahim, K. Y., Carvalho, N. B., Mimicos, E. V., Yeh-Li, H., Sotto, M. N., França, F. O. S.
Format:	Journal Article
Language:	English
Published:	Dordrecht Springer Netherlands 01-10-2014 Springer Springer Nature B.V
Subjects:	Adult Allografts Amphotericin B Amphotericin B - therapeutic use Antifungal Agents - therapeutic use Antiparasitic agents Bacterial infections Biomedical and Life Sciences Biopsy Bone marrow Bone Marrow - microbiology Bone Marrow - pathology Bone Marrow Diseases - diagnosis Bone Marrow Diseases - microbiology Bone Marrow Diseases - pathology Bone Marrow Diseases - therapy Case reports Dermatomycoses - diagnosis Dermatomycoses - microbiology Dermatomycoses - pathology Dermatomycoses - therapy Disease prevention Eukaryotic Microbiology Female Fever Fungal infections Health aspects Histoplasma Histoplasma - isolation & purification Histoplasmosis Histoplasmosis - diagnosis Histoplasmosis - microbiology Histoplasmosis - pathology Histoplasmosis - therapy Humans Immunocompromised Host Immunotherapy Itraconazole Kidney Transplantation Kidney transplants Kidneys Life Sciences Liver Medical Microbiology Microbial Ecology Microbiology Neutrophils Organ transplant recipients Organisms Parasitic diseases Plant Sciences Plastic surgery Skin Skin & tissue grafts Skin Transplantation Skin Ulcer - microbiology Skin Ulcer - pathology Transplant Recipients Transplantation Treatment Outcome Yeast Brazil Infection Histoplasmosis Transplantation Renal allograft
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12–18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0301-486X 1573-0832
DOI:	10.1007/s11046-014-9793-x