Abstract: SA-PO875
Disseminated Histoplasmosis (DH) Involving the Central Nervous System in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Hernandez, Antonette Veronica B., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Concepcion, Beatrice P., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction
Endemic fungal infection is rare but well documented in immunocompromised (IC) hosts where the most common presentation is DH. Of the endemic fungi, infection with Histoplasma capsulatum is the most common. Even so, the incidence of disseminated histoplasmosis in IC patients in endemic areas is low at <1%. Here we present a case of DH with CNS involvement in a kidney transplant recipient.
Case Description
A 40-year-old man with ESRD from HTN and T2DM received a DDKT in 2018 and was maintained on tacrolimus, mycophenolic acid, and prednisone. He presented with dyspnea and malaise over 3 weeks. Scr on admission was 5.45 mg/dl (baseline of 1.3 mg/dL). On hospital day 2, he became altered. MRI brain revealed 2 left-sided ring-enhancing lesions in the frontal/parietal region, concerning for “septic emboli.” A TTE was negative for vegetations. Chest CT showed mild tree-in-bud nodularity and GGO, but no granulomas. Initial blood and urine cultures were negative. Urine and serum histoplasmosis Ag were above the limit of quantification. He was diagnosed with DH with CNS abscesses and started on Liposomal Amphotericin B 5mg/kg daily every 24 hours. CSF analysis showed pleocytosis, elevated protein, and low glucose. CSF histoplasma Ag was positive at 1.93ng/mL and CSF culture was negative. The initial fungal blood culture returned positive for H. capsulatum 4 weeks later.
Discussion
Only 5 to 10% of DH infections involve the CNS. Routes of infection include donor-derived, reactivation, and de-novo infection, the latter of which is suspected in this patient with no prior evidence of latent disease on chest imaging. Additionally, most cases of donor-derived infection occur within the first few months of transplant. Without obvious neurological symptoms, CNS involvement may be missed. Thus, a high clinical suspicion is necessary for prompt diagnosis and treatment.