Fulminant sepsis due to disseminated histoplasmosis in renal transplantation: A diagnostic challenge

AbstractDisseminated histoplasmosis can be extremely life threatening if not identified and treated promptly. Diagnosing fungal infections in patients receiving solid organ transplants and in those who are immunosuppressed is pivotal in prevention of fungal sepsis. These patients may present with subtle chronic symptoms prior to sepsis. The patient, a 77-year-old woman who had a kidney transplant from a living related donor about 26 years previously, presented with recurrent skin rash and muscle weakness for 4 months. Her skin biopsy showed nonspecific granulomas prior to admission. On presentation she remained critically ill, and her radiographic imaging or cultures did not show specific abnormalities throughout the disease course, except for a positive urine histoplasma antigen and serum histoplasma polymerase chain reaction. Her clinical status deteriorated eventually leading to death. This case highlights the importance of rapid diagnostic tests in the early diagnosis of disseminated histoplasmosis, which could potentially prevent fulminant sepsis