Disseminated histoplasmosis in a liver transplant recipient.
A 61-yr-old liver transplant recipient presented with abdominal cramping and nonbloody diarrhea resulting in orthostasis. Multiple ulcerations throughout the colon were seen during endoscopy, and biopsies from the ulcer edges revealed histoplasmosis. Treatment with a course of itraconazole improved the diarrhea. The patient later presented with pericarditis and symptomatic pleural effusions, the latter of which was confirmed to be a result of disseminated histoplasmosis. Treatment with amphotericin B led to resolution. Histoplasmosis should be considered in liver transplant patients with diarrhea and large ulcers in the colon. The presence of disseminated histoplasmosis should be ruled out once colonic histoplasmosis has been diagnosed.
Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Young S
YS
Oh
Mauricio
M
Lisker-Melman
Kevin M
KM
Korenblat
Gary R
GR
Zuckerman
Jeffrey S
JS
Crippin
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000209:etiology; D010996:Pleural Effusion / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis*; D012086:Reoperation; D016896:Treatment Outcome
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B