Histoplasmosis as a late infectious complication following heart transplantation in a patient with Chagas' disease

Abstract

Infectious complications following heart transplantation are an important cause of morbidity and mortality. Generally, bacterial infections are predominant; however, fungal infections can be responsible for up to 25% of infectious events. We report the case of a patient who presented with histoplasmosis as an infectious complication five years after heart transplantation due to a chagasic cardiopathy. This association has rarely been reported in the international literature.

Disseminated histoplasmosis manifesting as a soft‐tissue chest wall mass in a heart transplant recipient

“…Disseminated disease has been well described in organ transplantation recipients receiving chronic immunosuppressive therapy (2, 3). However, histoplasmosis infection in heart transplantation patients, as in the present case, is rare (4). Given his history of prolonged exposure to birds, the patient most likely acquired an earlier asymptomatic infection of pulmonary histoplasmosis commonly seen in healthy individuals (5).…”

Histoplasmosis in transplant recipients

“…The initial clinical features of PTH may be nonspecific, often resulting in a significant delay in diagnosis resulting in a poor outcome. 16,[42][43][44][45][46] There is usually a median interval of 2-3 weeks between the onset of symptoms and diagnosis. 20,23,25,33 Severity may vary over a wide range, from an indolent disease with vague symptoms for several weeks to months 16,35,47 to an aggressive septic picture.…”

“…The initial clinical features of PTH may be nonspecific, often resulting in a significant delay in diagnosis resulting in a poor outcome . There is usually a median interval of 2‐3 weeks between the onset of symptoms and diagnosis .…”

I Diretriz Latino-Americana para o Diagnóstico e Tratamento da Cardiopatia Chagásica

“…Benznidazole is the preferred drug, nifurtimox being the second option, including for parasite strains resistant to the former 308,309 . Although experience with a small number of patients has reported the effectiveness of allopurinol, that treatment is not recommended [310][311][312] .…”