title: Disseminated histoplasmosis associated with hemophagocytic lymphohistiocytosis in kidney transplant recipients.
abstract: Transplant patients are susceptible to infectious complications due to chronic immunosuppression. We present two cases of persistent fever, weight loss and pancytopenia in kidney transplant recipients (originally concerning for posttransplant lymphoproliferative disease) that were later diagnosed with disseminated histoplasmosis on bone marrow and lymph node biopsy. In both patients, pancytopenia was due to hemophagocytic lymphohistiocytosis (HLH) which has rarely been described in association with histoplasmosis and not previously reported in kidney transplant recipients with this fungal infection. The diagnosis of histoplasmosis can be complex due to nonspecific symptomatology, delays in isolating histoplasma by fungal culture and false-negative antibody titers in immunocompromised patients. A review of the literature including the clinical features of histoplasmosis in immunosuppressed patients (prevalence, current diagnostic testing and treatment options) as well as the association of HLH in immunocompromised states are discussed.
authors.affiliation: Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Lo
authors.forename: J Q
authors.initials: JQ
authors.lastname: Mo
authors.forename: B P
authors.initials: BP
authors.lastname: Dixon
authors.forename: K A
authors.initials: KA
authors.lastname: Czech
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology; D005188:False Negative Reactions; D005260:Female; D006660:Histoplasmosis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D051437:Renal Insufficiency / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents