Laryngeal histoplasmosis in a kidney transplant recipient

Abstract

Histoplasma capsulatum is an endemic fungus that most oftenly causes a self‐limiting illness but can result in severe infections in immunocompromised patients including pulmonary or extra‐pulmonary disease. Rarely it can also cause a chronic progressive infection of the larynx. Herein, we report a case of laryngeal histoplasmosis in a kidney transplant patient who presented with progressive symptoms of several weeks of hoarseness, dysphagia and odynophagia. Laryngoscopic examination revealed thick plaques in the oropharynx with surrounding hyper‐erythema and histopathology showed numerous intracellular yeasts forms consistent with H capsulatum. Patient was initiated on treatment with itraconazole. Infection of the larynx due to H capsulatum is highly uncommon and therefore can result in an inappropriate or delayed diagnosis. A review of literature showed four previously reported cases of laryngeal histoplasmosis in patients with solid organ transplant. This is the first case series of laryngeal histoplasmosis in transplant recipients.

Long-Term Infectious Complications of Kidney Transplantation

“…Histoplasmosis occurs in 0.1%-0.3% of kidney transplant recipients, at median of 2-5 years post-transplant (81)(82)(83). The most common presentation in kidney transplant includes pneumonia and disseminated disease, but rare presentations occur with cutaneous lesions and hemophagocytic lymphohistocytosis (82)(83)(84)(85). Risk factors included leukopenia, CMV, and a diagnosis of bacterial pneumonia (81).…”

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

“…There were 172 cases of histoplasmosis described in 125 reports [ 66 , 69 , 72–87 , 90–99 , 101–182 , 194 , 196 , 197 , 199–206 , 208 , 241–243 ] ( Table 1 ). Half of recipients (74 of 144 [51.4%]) were on MMF [ 73 , 74 , 80 , 83–86 , 92–94 , 96 , 98 , 101–104 , 107–109 , 113–116 , 118–120 , 122 , 126 , 130 , 132–135 , 140 , 143 , 145 , 148–150 , 152 , 153 , 155 , 156 , 159 , 161–165 , 172–174 , 177 , 179 , 181 , 194 , 196 , 197 , 204 ]. T-cell–depleting induction was reported in 23 cases [ 78 , 104 , 107 , 108 , 110 , 113–115 , 118 , 125 , 133 , 146 , 154 , 163 ] while acute rejection occurred in 30 recipients within 1–3 months before symptom onset […”

“…Nineteen coinfections were described ( Supplementary Material, Appendix 2 ) [ 97 , 101 , 108 , 122 , 128 , 129 , 153 , 159 , 163 , 171 , 180 , 199 , 208 , 243 ]. Of the 42 patients who died [ 74 , 77–79 , 81 , 82 , 84 , 87 , 90 , 95 , 108 , 115 , 127 , 128 , 139 , 141 , 142 , 148 , 153 , 155 , 159–161 , 163 , 164 , 171 , 178 , 179 , 181 , 199–201 , 208 , 241–243 ], the majority had disseminated histoplasmosis (39 of 42 [92.9%]).…”

Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: A case report

“…Clinical awareness is needed to suspect and diagnose the underlying genetic defects that cause invasive fungal infections. In the case of inborn errors of (Reibel et al, 1982;Samuel and Wolff, 1986;Khalil et al, 2019) Sex Male 50 (Moriones and Guerra, 2014;O'Connell et al, 2018;John et al, 2015;Samuel and Wolff, 1986;Singh et al, 2012;Tseng et al, 2005) Female 5 (Sataloff et al, 1993;Cairoli et al, 2010;Tai et al, 2010;Bahri et al, 1972;Durand et al, 2014) Basic disease Diabetes 7 (Subramaniam et al, 2005b;Phatak et al, 2006;Khalil et al, 2019;Teoh et al, 2013;Durand et al, 2014;Mackowiak, 2013;Rappo et al, 2010) HIV 5 (Sacoor, 2017;Solari et al, 2007;Troncoso et al, 2003;Sanmani et al, 2011;Pochini et al, 2007) Kidney transplantation 4 (Moriones and Guerra, 2014;Khalil et al, 2019;Jawale and Gulwani, 2017;Rappo et al, 2010 (Gerber et al, 1995) Other involved sites Lung 22 (Coiffier et al, 1998;Reibel et al, 1982;Wolf et al, 2004b;Cairoli et al, 2010;John et al, 2015;Frank et al, 2014;Pickard and Kotzen, 1973;Samuel and Wolff, 1986;Fletcher and Prussin, 1990;Klein et al, 2005;…”