Histoplasmosis and subcutaneous nodules in a kidney transplant recipient: erythema nodosum versus fungal panniculitis

Abstract

Erythema nodosum (EN)-like lesions are a rare occurrence after solid organ transplantation. Differential diagnosis includes infective panniculitis, which can be a feature of progressive disseminated histoplasmosis (PDH), an uncommon but severe form affecting primarily immunocompromised hosts. We report on a fatal case of PDH, which presented as fungal panniculitis masquerading as EN in a renal allograft recipient 25 years after transplantation. We discuss the clinical, histopathological, and microbiological characteristics of this rare complication, with focus on its distinction from EN. This case emphasizes the central role of biopsy in transplant recipients presenting with cutaneous lesions, and the importance of clinicopathologic correlation and complementary microbiological investigations.

Infectious panniculitis: an inpatient cohort

“…2 The effectiveness of the anti-CD20 monoclonal antibody rituximab for SS is only anecdotic at current. 3,4 Therefore, we herein report a new patient with multiresistant SS treated with a single cycle of rituximab and followed up until the subsequent disease relapse.…”

“…Given their overlapping presentation and shared infectious etiologies, clinical impression alone is rarely sufficient to differentiate EN from infectious panniculitis. Furthermore, infectious panniculitis and EN may share common histopathologic features 3. In our cohort, special histopathology stains, tissue cultures, and auxiliary diagnostic testing were necessary to confirm the infectious organism.…”

Endemic Mycoses in Solid Organ Transplant Recipients

“…Almost any site can ultimately be involved however; rare cases of histoplasmosis in SOT recipients are reported involving the adipose tissue and tonsils. 5,29 Patients can also present with an undifferentiated sepsis picture.…”

Histoplasmosis in transplant recipients

“…10 The majority of PTH occurs within the first 2 years following transplantation, but sporadic cases continue to manifest even years later; cases occur as early as a few days to more than 20 years following transplant. [29][30][31][32][33] In the early occurring cases, donor-derived infection (DDI) or the presence of infection in the recipient that was undiagnosed prior to transplantation is possible. The median time to diagnosis varies among studies, depending on the sample size, use of antifungal prophylaxis, timeliness of diagnosis, and the duration of follow-up.…”

“…In the largest study of PTH in SOT between 2003 and 2010 at 24 sites in the United States, kidney transplant recipients accounted for half of the 152 reported cases . The majority of PTH occurs within the first 2 years following transplantation, but sporadic cases continue to manifest even years later; cases occur as early as a few days to more than 20 years following transplant . In the early occurring cases, donor‐derived infection (DDI) or the presence of infection in the recipient that was undiagnosed prior to transplantation is possible.…”