Cutaneous presentation of progressive disseminated histoplasmosis nine years after renal transplantation

Abstract

Initial presentation of invasive fungal infections such as histoplasmosis can include non-specific clinical manifestations, especially in immunocompromised patients. A high index of suspicion is required to identify atypical manifestations of these diseases, which carry a high risk of mortality, if the diagnosis is delayed or missed. We describe a case of a kidney transplant recipient with cutaneous lesions as initial manifestation of progressive disseminated histoplasmosis where a skin biopsy was crucial to an early diagnosis.

Cutaneous histoplasmosis in renal transplant recipients

“…In two patients, direct transmission of histoplasmosis through cadaveric renal transplantation was implicated, and these patients presented in the early post-transplantation period at around two months (4,9). The other patients presented out of this one-yr window, with a wide range including up to 29 yr after transplant ( Seventeen of these 22 cutaneous histoplasmosis cases, including our patient, occurred in the setting of confirmed disseminated disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Table 1 displays the demographic data, time from transplantation to clinical presentation, maintenance immunosuppressants, characteristics of cutaneous findings, other organs with confirmed involvement, treatment medications, and final outcome of these 17 cases.…”

“…Seventeen of these 22 cutaneous histoplasmosis cases, including our patient, occurred in the setting of confirmed disseminated disease . Table displays the demographic data, time from transplantation to clinical presentation, maintenance immunosuppressants, characteristics of cutaneous findings, other organs with confirmed involvement, treatment medications, and final outcome of these 17 cases.…”

“…Our literature review yielded 22 cases of cutaneous histoplasmosis in renal transplant patients, including a patient seen on our inpatient consult service (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The median age in this series was 38 yr, and the majority of cases were reported in males (68%).…”

Lesiones cutáneas en pacientes con trasplante renal en el Hospital Universitario San Ignacio

“…Sin embargo, en otros estudios las infecciones en pacientes trasplantados se han presentado con frecuencias del 50,81 % para infecciones virales, del 16,39 % para tumores benignos, del 15,3 % para lesiones premalignas o malignas, del 14,21 % para micosis, del 16,29 % para xerosis y del 8,74 % para dermatitis. En algunos casos se han reportado infecciones raras, como angiomatosis cutánea bacilar [12], feohifomicosis cutánea [13], histoplasmosis diseminada [14], tripanosoma cruzi [15], reactivación letal de varicela zóster [16], micobacteriosis atípicas [17] o nódulos subcutáneos como expresión de infecciones micóticas o por micobacterias [18].…”

Histoplasmosis outbreak in Tamboril cave—Minas Gerais state, Brazil

“…Histoplasmosis can progressively disseminate and is diagnosed by chest radiograph, histology and microbiology and if it is not treated, it can be fatal [1,15,16] . Facing that, the health programs should develop to investigate fungus incidence, mostly on tropical areas as observed in Brazil [2,17] .…”