An unexpected cause of refractory thrombocytopenia in post renal transplant patient

Abstract

Post renal transplant patient often present with cytopenias including thrombocytopenia, this could be multifactorial including the immunosuppressive drugs, viral infections. Patient need immediate supportive treatment. The underlying etiology needs to be identified and treated. One of the less suspected cause is opportunistic infection like disseminated histoplasmosis. Progressive disseminated histoplasmosis is an uncommon opportunistic infection, largely affecting immunocompromised individuals, among organ transplant patients most commonly occur in post kidney transplant and patients on calcinurin inhibitor. The initial manifestation are fever, weight loss, hepatosplenomegaly, thrombocytopenia to an acute, rapidly fatal course causing resp. failure, shock, coagulopathy and multiorgan failure. Diagnosis can we made by histoplasma antigen assay or demonstration of histoplasma among tissue and bone marrow biopsy. Treatment include Intravenous amphotericin B with Long term itraconazole. We present an interesting case of disseminated histoplasmosis in post renal transplant patient presented with rashes, bleeding manifestation and severe thrombocytopenia, interestingly thrombocytopenia