title: Belatacept and mediastinal histoplasmosis in a kidney transplant patient.
abstract: BACKGROUND
  In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the risk of infections, metabolic and hemodynamic complications or even of malignancy, but may expose patients to episodes of acute rejection. New drugs are being developed to improve graft survival at the lowest risk of side effects. Belatacept has recently been introduced in kidney transplantation to inhibit the co-ligand signal of T cell stimulation. It is a drug with a safe profile, is well-tolerated and appears to improve long-term survival of kidney grafts. However, there may be an increase in opportunistic infections which may be facilitated by T cell depression, as Aspergillus sp., Cryptococcus neoformans or tuberculosis.
  
  
  METHODS
  We describe a 59-year-old female who developed fever, clinical wasting and a mediastinal mass 31 months after receiving a living non-related kidney transplant while on belatacept therapy. A mediastinal node biopsy disclosed the presence of Histoplasma capsulatum. Infection successfully resolved after appropriate antifungal treatment.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapy.
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Hernán
authors.initials: H
authors.lastname: Trimarchi
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Rengel
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: José
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Paulero
authors.affiliation: Pathology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Iotti
authors.affiliation: Microbiology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Agustina
authors.initials: A
authors.lastname: Forastiero
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lombi
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Pomeranz
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Forrester
authors.affiliation: Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Romina
authors.initials: R
authors.lastname: Iriarte
authors.affiliation: Microbiology Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Iris
authors.initials: I
authors.lastname: Agorio
keywords: Belatacept; Histoplasma capsulatum; Kidney transplantation