Histoplasmosis in Liver Transplant Recipients: Case Reports and a Review of the Literature

Abstract

We report two cases of histoplasmosis in orthotopic liver transplant (OLT) recipients to illustrate the variable presentations, complications encountered during treatment, the spectrum of diagnostic modalities, and case outcomes. Case 1 describes the insidious presentation of presumed gastrointestinal histoplasmosis 12 years after OLT, which was defined by months of intermittent diarrhea and focal colonic disease on colonoscopy. A diagnosis of Histoplasma capsulatum was ultimately made by broad range PCR performed on colonic tissue. Due to the patient’s inability to tolerate itraconazole, treatment consisted of two weeks of liposomal amphotericin B with resolution of colonic ulcers on follow-up colonoscopy. Case 2 illustrates a case of severe pulmonary histoplasmosis with dissemination in an OLT recipient one year after transplantation. Treatment was complicated by the development of acute respiratory distress syndrome requiring mechanical ventilation and hemodynamic shock requiring extracorporeal membrane oxygenation therapy. A review of the literature on histoplasmosis in OLT recipients accompanies our cases and emphasizes the epidemiology, clinical manifestations, diagnosis, treatment, and prevention.