Disseminated histoplasmosis in a heart transplant recipient from Saudi Arabia: A case report.

Autor:	Alamri M; Section of Infectious Diseases, Department of Medicine King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Electronic address: malamari70@kfshrc.edu.sa., Albarrag AM; Medical Microbiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Khogeer H; Section of Hematopathology, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Saudi Arabia., Alburaiki J; Adult Cardiology, Heart Centre King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Halim M; Section of Infectious Diseases, Department of Medicine King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Almaghrabi RS; Section of Infectious Diseases, Department of Medicine King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	Journal of infection and public health [J Infect Public Health] 2021 Aug; Vol. 14 (8), pp. 1013-1017. Date of Electronic Publication: 2021 May 27.
DOI:	10.1016/j.jiph.2021.05.012
Abstrakt:	Histoplasma is endemic in North and Central America. We describe a case of disseminated histoplasmosis in a heart transplant recipient outside the known endemic areas. A 68-year-old gentleman known to have dilated cardiomyopathy. He underwent left ventricular assist device (LVAD) implantation in India and 2 years later did heart transplant in King Faisal Specialist and Research Center Hospital. Six weeks post-transplant he presented with headache and fever. All investigations were negative, and he was discharged home. Four days after discharge he presented with headache, fever, blurred vision, and an episode of loss of consciousness. Examination showed an ill looking patient who is highly febrile. Repeated work up showed pancytopenia. A repeat LP was negative. Bone marrow biopsy showed Small intracellular organisms. Extended work up revealed a positive Histoplasma urinary antigen, positive Histoplasma PCR from the bone marrow biopsy. Patient was started on Liposomal Amphotericin followed by Itraconazole with marker clinical improvement. This is the first reported case of disseminated Histoplasmosis in Saudi Arabia. We postulate that the patient had reactivation of a latent infection acquired at the time of LVAD insertion in India rather than donor derived infection by the negative fungal culture and PCR done on the donor's lung granuloma tissue. (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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