A Case of Pulmonary Histoplasmosis Presenting with Hypercalcemia and Altered Mental Status in a Patient Following Allogeneic Hematopoietic Stem Cell Transplantation

Rodriguez, Jose A.; Ivancic, Stipe; Eckardt, Paula; Lemos-Ramirez, Juan; Niu, Jianli

doi:10.12659/ajcr.919724

Cited by 9 publications

(12 citation statements)

References 7 publications

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“…There were 16 published reports on endemic fungal infection after HSCT that met the criteria for inclusion in this review. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The majority of these reports were from the United States, and there was one report each from India, 14 from Turkey, 3 and from Hong Kong. 17 These 16 reports described nine cases of histoplasmosis, 2,[5][6][7]9,11,13,14,16 seven cases of coccidioidomycosis, 4,8,10,12,15 and two cases of talaromycosis.…”

Section: Resultsmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The majority of these reports were from the United States, and there was one report each from India, 14 from Turkey, 3 and from Hong Kong. 17 These 16 reports described nine cases of histoplasmosis, 2,[5][6][7]9,11,13,14,16 seven cases of coccidioidomycosis, 4,8,10,12,15 and two cases of talaromycosis. 3,17 There were no published cases of paracoccidioidomycosis and blastomycoses among HSCT recipients.…”

Section: Resultsmentioning

confidence: 99%

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A review of endemic mycoses after hematopoietic stem cell transplantation

Abad,

Razonable

2023

Transplant Infectious Dis

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BackgroundEndemic mycoses after hematopoietic stem cell transplantation (HSCT) are rarely reported. We aimed to comprehensively review the clinical presentation and outcomes of endemic mycoses in this immunocompromised population.MethodsMultiple databases were reviewed from inception through May 31, 2023 using endemic fungi as keywords (e.g., coccidioides, histoplasma, blastomyces, talaromyces, and paracoccidioides). Only hematopoietic transplants were included.ResultsThere were 16 publications on endemic mycoses after HSCT that reported nine unique cases of histoplasmosis, seven coccidioidomycosis, and two talaromycosis. No cases of paracoccidioides and blastomycoses were identified. Fifteen cases were allogeneic hematopoietic transplant recipients and three were autologous. Many were male (14/18, 77.8%) and overall median age was 50 (range 21–75) years. Among the 16 patients with coccidiodomycosis or histoplasmosis, fever, cytopenias and disseminated disease were the most common clinical presentations, with median onset of 8 or 12 months after HSCT, respectively. Likewise, the two HSCT patients with talaromycosis presented with disseminated disease at 12 and 48 months after transplantation. The vast majority were not on effective azole prophylaxis at the time of presentation, and many had recent intensification of immunosuppression. Nine of 18 patients died (50%), and all deaths occurred among patients with disseminated endemic mycoses.ConclusionEndemic mycoses among HSCT are uncommon. Onset was late, after discontinuation of azole prophylaxis, or was associated with intensification of immunosuppression. Disseminated disease was a common presentation, manifested by fever and cytopenias. Attributable mortality was high, and emphasizes the need for a high index of clinical suspicion so that prompt diagnosis and treatment is provided. image

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A review of endemic mycoses after hematopoietic stem cell transplantation

Abad,

Razonable

2023

Transplant Infectious Dis

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“…PDH can also present with severe electrolyte imbalance, which may be secondary to involvement of the adrenal glands [ 80 ]. PDH is a rare cause of 1,25-dihydroxy vitamin-D-mediated hypercalcemia [ 81 ].…”

Section: Progressive Disseminated Histoplasmosismentioning

confidence: 99%

Pulmonary Histoplasmosis: A Clinical Update

Barros

Wheat²,

Hage

2023

JoF

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Histoplasma capsulatum, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. The most common clinical presentations include pulmonary histoplasmosis, which can resemble community-acquired pneumonia, tuberculosis, sarcoidosis, or malignancy; however, certain patients can develop mediastinal involvement or progression to disseminated disease. Understanding the epidemiology, pathology, clinical presentation, and diagnostic testing performance is pivotal for a successful diagnosis. While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as “step-down” therapy after initial improvement with amphotericin B. In this review, we discuss the current epidemiology, pathology, diagnosis, clinical presentations, and management of pulmonary histoplasmosis.

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“…Another enigma with the second episode is the concurrence of hypercalcemia. However, voriconazole-associated hypercalcemia was reported to occur in patients with acute leukemia 12,13) . Voriconazole alone was not considered to cause hypercalcemia, but it should exert a synergistic effect on hypercalcemia via drug interactions 12) or add to an underlying hypercalcemia-prone disease such as fungal granulomas 13) .…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…However, voriconazole-associated hypercalcemia was reported to occur in patients with acute leukemia 12,13) . Voriconazole alone was not considered to cause hypercalcemia, but it should exert a synergistic effect on hypercalcemia via drug interactions 12) or add to an underlying hypercalcemia-prone disease such as fungal granulomas 13) . Our case had monoclonal gammopathy with light chain deposition disease, but it was not linked to hypercalcemic conditions because no osteolytic lesions were involved.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Voriconazole-induced Severe Hyperkalemia Precipitated by Multiple Drug Interactions

Choi

Cho

Jang

et al. 2020

Electrolyte Blood Press

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Voriconazole, a triazole antifungal agent used to treat serious fungal infections, has a pharmacokinetic characteristic of undergoing hepatic metabolism by the cytochrome P450 system. Few cases of hyperkalemia have been reported, which presented only when the serum voriconazole level was exceptionally elevated by drugdrug interactions. Additionally, azole antifungals may interfere with the biosynthesis of adrenal steroids and therefore can predispose patients to aldosterone deficiency. However, it is unclear whether voriconazole itself can induce hypoaldosteronism or hyperkalemia. Here, we report a case of voriconazole-induced hyperkalemia in a patient administered concurrent medications to treat comorbidities. Voriconazole was orally administered for pulmonary aspergillosis, and three episodes of severe hyperkalemia recurred, which improved with emergency treatment. In the first episode, renin-angiotensin-aldosterone system inhibitors were associated. We found that dronedarone might have increased the voriconazole level in the second episode. At that time, severe hypercalcemia was concurrent, which improved with acute hemodialysis and eliminating dronedarone. Finally, severe hyperkalemia recurred without concurrent medications known to interact with voriconazole. Upon switching from voriconazole to itraconazole, the hyperkalemia was resolved. Drug level monitoring is necessary when voriconazole is used. Genetic susceptibility, such as through CYP2C19 polymorphism, may be investigated for patients with adverse reactions to voriconazole.

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A Case of Pulmonary Histoplasmosis Presenting with Hypercalcemia and Altered Mental Status in a Patient Following Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 9 publications

References 7 publications

A review of endemic mycoses after hematopoietic stem cell transplantation

A review of endemic mycoses after hematopoietic stem cell transplantation

Pulmonary Histoplasmosis: A Clinical Update

Voriconazole-induced Severe Hyperkalemia Precipitated by Multiple Drug Interactions

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