Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India

Abstract

W.W. Baig, R.P. Attur, A. Chawla, S. Reddy, S. Pillai, L. Rao, G. Rao, K. Ashok, P. Yegneswaran. Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India. Transpl Infect Dis 2011: 13: 489–491. All rights reserved Abstract: An unusual case of epididymal and prostatic histoplasmosis is reported from Karnataka State of southern India, in a 37‐year‐old male renal transplant recipient, who had presented with gastrointestinal histoplasmosis a year before the second presentation and had responded successfully to 9 months' treatment with itraconazole. The patient presented a second time with high‐grade fever and pain in the scrotum and the lower abdomen. Ultrasound of the abdomen revealed a retrotrigonal abscess, which was confirmed on computed tomography scan of the pelvis. Pus was drained via transrectal route and biopsy specimens were taken from the epididymis and the prostate. Histopathology revealed the picture suggestive of histoplasmosis, and the pus on culture confirmed the infection with Histoplasma capsulatum. To our knowledge, only 5 cases of epididymal histoplasmosis have been reported in the literature, our case being the second report from India and sixth in the world; prostatic histoplasmosis is also a rare occurrence.

Endemic Fungal Infections in Solid Organ Transplantation

“…Histoplasmosis is an opportunistic fungal infection caused by the dimorphic fungus, Histoplasma capsulatum . Although found in many areas of the world such as South America, India and Bangladesh , the organism is endemic in the Ohio and the Mississippi River valleys in the United States. The clinical spectrum of infection ranges from a self limited febrile illness to severe multi‐organ dysfunction, depending on the size of the host inoculum and immune status of the infected individual.…”

“…As the infection progresses, associated clinical findings include hepatosplenomegaly, pneumonia, gastrointestinal involvement, pancytopenia, weight loss, hepatic enzyme elevations, mucosal/skin findings and increased lactate dehydrogenase levels. Any organ can be involved with Histoplasma as cases of septic arthritis and prostatitis have been described in transplant recipients . Unusual presentations in more severely ill patients have also been reported as part of the clinical picture, such as thrombotic microangiopathy and hemophagocytic lymphohistiocytosis .…”

Methicillin-ResistantStaphylococcus aureusProstatic Abscess in a Liver Transplant Recipient

“…The associated organisms were Histoplasma capsulatum [14, 15], Cladophialophora carrionii [16], Pseudomonas aeruginosa [17], and Cryptococcus neoformans [18]. In the cases of the renal transplant patients, the prostatic abscess was found at 2.5 and 3 years ( Histoplasma ), 10 months ( Cladophialophora ), and 6 days ( Pseudomonas ) after transplant.…”

Mucocutaneous Histoplasmosis in immunocompetent adult patients

“…It has also been reported by Chaurasia et al in 2007 in a patient with penoscrotal histoplasmosis following bladder carcinoma 18 . A case of epididymal and prostatic histoplasmosis was reported from Karnataka State of southern India, in a 37-year-old male renal transplant recipient 19 . Another similar case was seen in a renal transplant recipient whose epididymal biopsy revealed histoplasmosis 20 .…”