A case of pulmonary histoplasmosis treated with voriconazole

Area of Science:

• Medical Mycology
• Infectious Diseases
• Pulmonology

Background:

• Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, primarily affecting the lungs, particularly in immunocompromised individuals.
• Patients on long-term immunosuppressive therapy, such as those post-transplantation, are at increased risk for opportunistic infections like histoplasmosis.

Observation:

• A 62-year-old male, 10 years post-heart transplant and on immunosuppressants, presented with a 3-month cough and multiple pulmonary nodules on CT scan.
• Lung biopsy confirmed Histoplasma capsulatum via culture and next-generation sequencing (NGS).

Findings:

• The patient was treated with voriconazole for 46 days, resulting in significant symptom relief and partial absorption of pulmonary lesions.
• Complete resolution of lesions was achieved after 13 months of voriconazole treatment, with no observed adverse effects.

Implications:

• This case highlights the successful use of voriconazole for pulmonary histoplasmosis, even in non-endemic areas, and in an immunocompromised patient.
• The successful management underscores the importance of considering fungal infections in transplant recipients and provides valuable insights into managing immunosuppressive and antifungal agents concurrently.