Abstract: SA-PO1007
Central Nervous System (CNS) and Ocular Involvement of Systemic Blastomycosis in a Kidney Transplant Recipient
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
- Larson, Hanna, Loyola University Medical Center, Maywood, Illinois, United States
- Jain, Drishti, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
- Garg, Ritu, Loyola University Medical Center, Maywood, Illinois, United States
Introduction
Blastomycosis dermatitidis is a fungal pathogen primarily affecting lungs. Immunocompromised patients, specifically solid organ transplant recipients, are at increased risk of disseminated blastomycosis. We describe a rare case of disseminated blastomycosis in a kidney transplant recipient with pulmonary, cutaneous, ocular, and CNS manifestations.
Case Description
A man aged 45 status post renal transplant due to post-streptococcal glomerulonephritis presented with fatigue, cough, and fever. Initial workup revealed leukocytosis and pulmonary micronodular lesions, tree-in-bud opacities and ground glass nodules on CT. Post admission the patient developed lower leg painless, flat, red macules that progressed to diffuse painful umbilicated pustules and papules. Skin biopsy showed broad-budding yeast cells, suggesting systemic blastomycosis. IV Amphotericin B was initiated. The patient then developed neck stiffness and encephalopathy. Blastomyces antigen in CSF confirmed leptomeningeal involvement. Palpebral fissure granulomas and culture identified mold, confirming chorioretinitis. During 4-weeks of Amphotericin B, the patient’s symptoms improved significantly. Due to high tacrolimus levels, hypovolemia, and Amphotericin B an AKI developed, resolving with tacrolimus reduction and IV fluids. He transitioned to voriconazole for a year of therapy.
Discussion
Disseminated blastomycosis CNS and ocular involvement is rare. It is challenging to diagnose given the range of clinical symptoms, especially in transplant recipients. This case emphasizes early recognition and treatment, specifically for ophthalmologic and neurologic manifestations, to prevent severe complications.
Inferior palpebral conjunctiva with 2 large granulomatous appearing lesions.