Disseminated blastomycosis in a kidney transplant recipient

Abstract

Disseminated blastomycosis in solid organ transplant is uncommon. The diagnosis is usually challenging due to vague clinical presentations, which could lead to a devastating outcome. We reported a unique case of disseminated blastomycosis with laryngeal involvement in a kidney transplant recipient who presented with hoarseness.The diagnosis was made by histopathology and culture of laryngeal mass.

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

“…A total of 268 SOT recipients with an endemic mycoses were described in 204 reports [ 4–8 , 13 , 16 , 18 , 20 , 21 , 23 , 25 , 27 , 28 , 33–37 , 40 , 42 , 45 , 46 , 48–52 , 55 , 58–61 , 64–70 , 72–88 , 90–99 , 101–146 , 148–168 , 170–183 , 186 , 188–197 , 207 , 209–244 ]. Table 1 summarizes their characteristics.…”

“…Thirty-one cases of blastomycosis were reported [ 7 , 8 , 13 , 20 , 21 , 23 , 35 , 45 , 46 , 48 , 51 , 52 , 55 , 59 , 60 , 64 , 65 , 67 , 68 , 70 , 195 , 209 , 211 , 244 ]. The majority of reports from the United States (10 of 16) were within endemic areas [ 20 , 21 , 35 , 45 , 46 , 51 , 60 , 67 , 195 , 211 ].…”

“…The majority of reports from the United States (10 of 16) were within endemic areas [ 20 , 21 , 35 , 45 , 46 , 51 , 60 , 67 , 195 , 211 ]. Eleven [ 8 , 13 , 23 , 35 , 48 , 52 , 64 , 65 , 68 , 70 , 209 ] had documented risk factors for disseminated infection, while this was unknown in 5 cases [ 7 , 55 , 59 , 211 , 244 ]. Five mentioned receipt of antithymocyte globulin [ 23 , 64 , 65 , 209 , 244 ], while 6 reported treatment for acute rejection before disease onset [ 59 , 64 , 65 , 68 , 209 , 244 ].…”

“…One patient was treated with methylprednisone for worsening graft function [ 70 ], and another had chronic cellular rejection [ 51 ]. The majority were receiving mycophenolate mofetil (MMF) (19 of 29 [65.5%]) [ 7 , 8 , 13 , 21 , 35 , 45 , 46 , 48 , 55 , 59 , 64 , 65 , 67 , 70 , 244 ].…”

“…Fever occurred in half of patients (11 of 22 [50%]) [ 7 , 8 , 20 , 21 , 23 , 35 , 51 , 64 , 65 , 195 , 209 ]. Slightly less than half had disseminated infection (15 of 31 [48.4%]) [ 8 , 13 , 23 , 35 , 45 , 51 , 52 , 60 , 64 , 67 , 68 , 211 ], followed by pulmonary infection alone (12 of 31 [38.7%]) [ 7 , 20 , 21 , 46 , 67 , 70 , 195 , 209 , 211 , 244 ] and isolated cutaneous involvement (4 of 31 [12.9%]) [ 48 , 55 , 59 , 65 ]. Sites of dissemination included skin and soft tissue (n = 8), joint (n = 2), central nervous system [CNS] (n = 5), larynx, (n = 2), liver (n = 1), spleen (n = 1), and peritoneum (n = 1).…”