Kidney Week

Abstract: SA-PO1011

Disseminated Histoplasmosis Manifesting as Oral Lesions in a Kidney Transplant Patient

Session Information

• Transplantation: Clinical - 4
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Hinojosa, Sebastian, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Sebastian Hinojosa, MD

• Nguyen, Alexis, Wayne State University School of Medicine, Detroit, Michigan, United States

Alexis Nguyen, MD

• Sosa, Piera A., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Piera A. Sosa, MD

• Richardson, Trey Howard, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Trey Howard Richardson, MD

• Gakhokidze, Levan, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Levan Gakhokidze, MD

• Ice, Alissa Angelica, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Alissa Angelica Ice, MD

• Langone, Anthony J., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Anthony J. Langone, MD

• Schaefer, Heidi M., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Heidi M. Schaefer, MD

Introduction

Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, is often asymptomatic in immunocompetent individuals. In immunocompromised hosts, Histoplasmosis can become disseminated and severe. Oral manifestations of histoplasmosis are rare and can pose a diagnostic challenge.

Case Description

A 72-year-old female who had undergone renal transplant 3 years prior presents to the ED with a 1-month history of painful oral lesions and weight loss of 20lbs. Her immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone.

Physical examination revealed a painful, irregularly shaped left lateral tongue ulceration with superficial sloughing and similar ulceration over the right buccal mucosa. There was palpable lymphadenopathy of the left anterior cervical chain.

Workup was notable for pancytopenia, elevated β-d-glucan, and positive urine histoplasma antigen. CT of the chest revealed ground glass nodular opacities bilaterally and abnormal bone marrow signal. Biopsies were performed revealing budding yeast forms consistent with Histoplasma capsulatum.

Discussion

This case illustrates several important points about histoplasmosis in the post-transplant population. Firstly, disseminated histoplasmosis can present with nonspecific symptoms such as mucosal ulcers and weight loss, which can mimic other post-transplant complications like drug reactions, malignancy, or other infections. Secondly, the diagnosis of histoplasmosis should be considered in immunosuppressed patients presenting with unusual lesions or systemic symptoms in endemic areas.

In our patient, management included reducing immunosuppression and treatment with amphotericin B followed by oral posaconazole. The patient improved after several weeks of treatment.