Saucedo-Crespo Hector, Mehta Tej, Sakpal Sujit Vijay, Auvenshine Christopher, Santella Robert N, Nazir Jawad, Steers Jeffrey
Avera McKennan Hospital & University Health Center, Sioux Falls, SD, United States.
Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States.
IDCases. 2020 Jan 2;19:e00692. doi: 10.1016/j.idcr.2019.e00692. eCollection 2020.
is typically an indolent disease among immunocompetent patients. However, immunocompromised patients, such as solid organ transplant recipients, are at risk of developing severe histoplasmosis. Yet post-transplant histoplasmosis is a rare pathology, representing less than five percent of invasive fungal infections among transplant recipients. Furthermore, patients tend to present with nonspecific clinical symptoms, complicating timely diagnosis and delaying treatment. Disease features that may be more representative of infection, such as anemia, leukopenia and pulmonary involvement are often not present until late in the disease course, when the patient is at greater risk of decompensation. Unlike infections among immunocompetent hosts, extrapulmonary infection among immunocompromised hosts is more the rule than the exception. Treatment with liposomal amphotericin B followed by oral itraconazole is the standard therapy, but special considerations must be made for patients with hepatic and/or renal insufficiency, underlying cardiac abnormalities or malabsorptive pathologies and doses of immunosuppressants will need to be adjusted for drug interactions. Herein we present a case of infection presenting with generalized lymphadenopathy post-renal transplant.
在免疫功能正常的患者中，通常是一种进展缓慢的疾病。然而，免疫功能低下的患者，如实性器官移植受者，有发生严重组织胞浆菌病的风险。然而，移植后组织胞浆菌病是一种罕见的病理情况，在移植受者的侵袭性真菌感染中占比不到5%。此外，患者往往表现出非特异性临床症状，使及时诊断变得复杂并延误治疗。可能更具感染代表性的疾病特征，如贫血、白细胞减少和肺部受累，通常直到疾病后期才出现，此时患者失代偿风险更高。与免疫功能正常宿主中的感染不同，免疫功能低下宿主中的肺外感染更为常见。脂质体两性霉素B随后口服伊曲康唑治疗是标准疗法，但对于有肝和/或肾功能不全、潜在心脏异常或吸收不良性疾病的患者必须进行特殊考虑，并且免疫抑制剂的剂量需要因药物相互作用而调整。在此我们报告一例肾移植后出现全身淋巴结病的感染病例。
