Pulmonary Histoplasma Infection After Allogeneic Hematopoietic Stem Cell Transplantation: Case Report and Review of the Literature

Natarajan, Mukil; Swierzbinski, Matthew J.; Maxwell, Sandra; Zelazny, Adrian M.; Fahle, Gary A.; Quezado, Martha; Barrett, John; Battiwalla, Minoo; Lionakis, Michail S.

doi:10.1093/ofid/ofx041

Cited by 14 publications

(21 citation statements)

References 12 publications

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“…There have been at least six previously reported cases of histoplasmosis associated with allogeneic hematopoietic stem cell transplantation [2]. There have been previously published cases of histoplasmosis associated with hypercalcemia [6].…”

Section: Discussionmentioning

confidence: 99%

“…A case is presented of pulmonary histoplasmosis presenting with nonspecific symptoms and hypercalcemia in the setting of allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML). Few cases have previously been reported of pulmonary histoplasmosis in patients following allogeneic hematopoietic stem cell transplantation [2].…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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Rare co-existance of disease or pathology Background: Histoplasmosis results from the inhalation of spores from the fungus, Histoplasma capsulatum. A case is presented of pulmonary histoplasmosis associated with altered mental state and hypercalcemia following allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML). Case Report: A 75-year-old man with a five-day history of AML treated with allogeneic hematopoietic stem cell transplantation, presented with weakness, fatigue, and slow mentation. Computed tomography (CT) of the brain was unremarkable. Laboratory investigations showed serum albumin of 2.9 g/dL, calcium of 11.6 mg/dL, ionized calcium of 1.55 mmol/L, parathyroid hormone (PTH) <6.3 pg/mL, and 25-hydroxy vitamin D of 14.4 ng/mL. Treatment began with intravenous cefepime 1 gm bid, normal saline, and the bisphosphonate, pamidronate, administered as a single dose. Three days later, his clinical status declined. He developed a dry productive cough, his oxygen saturation (O 2 Sat) was 90%, and his mental status worsened. Chest CT showed diffuse bilateral lung infiltrates with ground glass opacities. Bronchioalveolar lavage and transbronchial biopsy were negative for Pneumocystis jiroveci pneumonia (PJP). The CMV viral load was 195 IU/mL. Urinalysis for Histoplasma antigen and the Fungitell ® assay were positive. Treatment commenced with intravenous voriconazole (250 mg, bid) and ganciclovir (5 mg/kg, bid). A left lower lobe transbronchial lung biopsy was positive for Histoplasma capsulatum and negative for CMV. Conclusions: This case report has highlighted the need for awareness of the diagnosis of histoplasmosis in patients with allogeneic hematopoietic stem cell transplantation who present with an altered mental state in the setting of hypercalcemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In a prospectively collected series of solid organ and HSCT patients diagnosed with endemic mycoses, only three of 16,200 HSCT recipients of histoplasmosis were identified (0.02%) of which only one patient underwent an allogeneic transplant [16]. Overall, there have been an estimated seven cases of histoplasmosis reported in the allogenic HSCT population, of which four patients with reported outcomes died [2,4,5,7,17,18]. Furthermore, there have been no previously reported cases of histoplasmosis in patients where antifungal prophylaxis with agents that have clinical activity against Histoplasma were used as was in our reported case.…”

Section: Discussionmentioning

confidence: 99%

“…Typical signs and symptoms of H. capsulatum infection include fever, chills, myalgias, dry cough, and chest discomfort. In immunocompromised patients, the disease may become disseminated and if untreated, is usually fatal with a reported mortality rate of 67% in allogeneic hematopoietic stem cell transplant recipients [2]. Itraconazole and amphotericin are the first-line therapies for treatment of histoplasmosis; however, other antifungal agents such as voriconazole and posaconazole are thought to be active and have been utilized as salvage therapy [3].…”

Section: Introductionmentioning

confidence: 99%

Histoplasma capsulatum Infection in an Allogeneic Hematopoietic Stem Cell Transplant Patient Receiving Voriconazole Prophylaxis

Agrawal

Brinda

Farag

2020

Case Reports in Hematology

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Histoplasma capsulatum infection is a rare complication in the allogeneic stem cell transplant patients. Minimal guidance exists on how to appropriately manage histoplasmosis in these patients. We report a patient who developed Histoplasma pneumonia while receiving voriconazole prophylaxis at a therapeutic trough level. The patient experienced significant clinical improvement after initiation of itraconazole pharmacotherapy. We recommend a lower threshold for evaluation for histoplasmosis in allogeneic hematopoietic stem cell transplant recipients who live in endemic regions, regardless of their antifungal prophylactic regimen.

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“…106 Histoplasmosis is similarly infrequent in the bone marrow transplant population but appears to be more common in those with graftversus-host disease. 107 In contrast, histoplasmosis is the most common invasive fungal infection in patients on TNFα inhibitors. Despite the fact that histoplasmosis is well recognized in this population, diagnosis is often delayed and infection is associated with a mortality rate of 20%.…”

Section: Progressive Disseminated Histoplasmosismentioning

confidence: 99%

Current Concepts in the Epidemiology, Diagnosis, and Management of Histoplasmosis Syndromes

Azar

Loyd

Relich

et al. 2020

Semin Respir Crit Care Med

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Histoplasmosis is a global disease endemic to regions of all six inhabited continents. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. As a result of climate change and anthropogenic land utilization, the conditions suitable for Histoplasma capsulatum are changing, leading to a corresponding change in epidemiology. The clinical manifestations of histoplasmosis are protean, variably resembling other common conditions such as community-acquired pneumonia, tuberculosis, sarcoidosis, Crohn's disease, or malignancy. Making a successful diagnosis is contingent on a thorough understanding of epidemiology, common clinical presentations, and best testing practices for histoplasmosis. While most subclinical or self-limited diseases do not require treatment in immunocompetent patients, all immunocompromised patients and those with progressive disseminated disease or chronic pulmonary disease should be treated. Liposomal amphotericin B is the preferred agent for severe or disseminated disease, while itraconazole is adequate for milder cases and “step-down” therapy following response to amphotericin B. In this review, we discuss the current evidence-based approaches to the epidemiology, diagnosis, and management of histoplasmosis.

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Pulmonary Histoplasma Infection After Allogeneic Hematopoietic Stem Cell Transplantation: Case Report and Review of the Literature

Cited by 14 publications

References 12 publications

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

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

Histoplasma capsulatum Infection in an Allogeneic Hematopoietic Stem Cell Transplant Patient Receiving Voriconazole Prophylaxis

Current Concepts in the Epidemiology, Diagnosis, and Management of Histoplasmosis Syndromes

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