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Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
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Immunohistochemistry Test for the Lyssavirus Antigen Detection from Formalin-Fixed Tissues
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A difficult diagnosis: acute histoplasmosis.

Neeraj Singh1, Charles Pizanis1, John Davis1

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A kidney transplant recipient developed a fever of unknown origin. Diagnosis of histoplasmosis was confirmed by lymph node biopsy and successfully treated with antifungal medication.

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Area of Science:

  • Infectious Diseases
  • Transplant Medicine
  • Mycology

Background:

  • Fever of unknown etiology is a common challenge in immunocompromised patients, particularly solid organ transplant recipients.
  • Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum, endemic in certain regions, and can present with diverse clinical manifestations.

Observation:

  • A 43-year-old male kidney transplant recipient presented with persistent fever despite extensive workup.
  • Positron emission tomography (PET)-positive subcarinal lymphadenopathy was identified as a potential source of infection.

Findings:

  • Biopsy of the subcarinal lymph node revealed non-caseating granulomas with positive staining for yeast, indicative of histoplasmosis.
  • Clinical improvement and fever remission following the initiation of targeted antifungal therapy confirmed the diagnosis.

Implications:

  • This case highlights the importance of considering opportunistic infections like histoplasmosis in transplant recipients with unexplained fever.
  • Early diagnosis and prompt treatment are crucial for favorable outcomes in immunocompromised individuals with disseminated fungal infections.
  • Subcarinal lymph node biopsy can be a valuable diagnostic tool for identifying deep-seated infections in transplant patients.