Cover Image

Primary Cutaneous Histoplasmosis in a Renal Allograft Recipient

NINOO GEORGE G CGEORGE

Abstract


The occurrence of histoplasmosis
in renal allograft recipients is quite
rare. While cutaneous involvement secondary
to histoplasmosis has been reported
in up to 17 percent of patients
with disseminated disease, the occurrence
of isolated cutaneous involvement
is extremely rare. In this report, we describe
the occurrence of primary cutaneous
histoplasmosis involving the thigh in
a renal allograft recipient. A 27 year old
lady, who underwent renal transplantation
9 years ago, presented to us with
complaints of painful swelling of her right
thigh for 3 months. She noticed small
nodular, erythematous lesions on the lateral
aspect of her right thigh, which
gradually increased in size and coalesced
to form a diffuse erythematous
swelling. There was no history of fever or
trauma. She had diarrhea for 3 months,
which subsided after discontinuation of
mycophenolate mofetil. There was no
history to suggest any other organ involvement.
Skin biopsy revealed septal
granulomatous panniculitis with focal
lobular extension and occasional yeastlike
fungi. The tissue was sent for microbiological
analysis
which revealed Histoplasma capsulatum.
After a thorough workup to rule out disseminated
histoplasmosis, she was started
on oral itraconazole in renal adjusted
doses. The lesions started resolving in 1
week. The patient was advised to continue
itraconazole for at least one year. However,
due to financial constraints, she
stopped the medication after 3 months.
However, the lesions had completely resolved,
with no recurrence till the last follow
-up visit.


Full Text:

PDF

References


Cuellar-Rodriguez J, Avery RK, Lard M,

Budev M, Gordon SM, Shrestha NK, et

al. Histoplasmosis in solid organ transplant

recipients: 10 years of experience

at a large transplant center in an endemic

area. Clin Infect Dis Off Publ Infect Dis

Soc Am. 2009 Sep 1;49(5):710–6.

Freifeld AG, Iwen PC, Lesiak BL, Gilroy

RK, Stevens RB, Kalil AC. Histoplasmosis

in solid organ transplant recipients at

a large Midwestern university transplant

center. Transpl Infect Dis Off J Transplant

Soc. 2005 Dec;7(3-4):109–15.

Grim SA, Proia L, Miller R, Alhyraba M,

Costas-Chavarri A, Oberholzer J, et al. A

multicenter study of histoplasmosis and

blastomycosis after solid organ transplantation.

Transpl Infect Dis Off J Transplant

Soc. 2012 Feb;14(1):17–23.

Rao R. Recurrent Primary Cutaneous

Histoplasmosis In a Post Renal

Transplant Patient. J Nephrol Ren

Transplant [Internet]. 2008 Dec 23

[cited 2014 May 22];1(1). Available

from: http://www.jnrt.info/ojs/

i n d e x . p h p ?

jonal=jnrt&page=article&op=view&p

ath%5B%5D=8

Rekha A, Kindo AJ, Sounderarajan

P, Ravi A. Infection with Histoplasma

capsulatum in a renal transplant

recipient. Saudi J Kidney Dis

Transplant Off Publ Saudi Cent Organ

Transplant Saudi Arab. 2010

Nov;21(6):1115–7.

Clement CG, Loeffelholz MJ, Eltorky

MA, Tang Y-W, Williams-

Bouyer N. Mycobacterium haemophilum

and Histoplasma capsulatum

Coinfection in a Renal Transplant

Patient. J Clin Microbiol. 2011 Sep

;49(9):3425–8.

Bhowmik D, Dinda A k., Xess I,

Sethuraman G, Mahajan S, Gupta

S, et al. Fungal panniculitis in renal

transplant recipients. Transpl Infect

Dis. 2008 Aug 1;10(4):286–9.

Sayal S K, Prasad P S, Mehta A,

Sanghi S. Disseminated histoplasmosis:

cutneous presentation. Indian

J Dermatol Venereol Leprol

;69:90-1.

Wheat LJ, Connolly-Stringfield PA,

Baker RL, Curfman MF, Eads ME,

Israel KS, et al. Disseminated histoplasmosis

in the acquired immune

deficiency syndrome: clinical findings,

diagnosis and treatment, and

review of the literature. Medicine

(Baltimore). 1990 Nov;69(6):361–74.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

An initiative of The Tamil Nadu Dr M.G.R. Medical University