Disseminated histoplasmosis complicating bone marrow transplantation

Area of Science:

• Infectious Diseases
• Hematology
• Oncology

Background:

• Allogeneic bone marrow transplantation is a treatment for acute myelomonocytic leukemia.
• Graft-versus-host disease often requires long-term immunosuppression with prednisone.
• Patients from areas endemic for Histoplasma may be at risk.

Observation:

• A patient undergoing allogeneic bone marrow transplant developed clinically unrecognized disseminated histoplasmosis.
• Histoplasma organisms and granulomas were identified in bone marrow aspirate histology.
• The patient died on the 78th post-transplant day.

Findings:

• Disseminated histoplasmosis is a previously undescribed complication of bone marrow transplantation.
• Bone marrow aspiration with clot sections is a sensitive and rapid diagnostic method.
• Febrile, immunosuppressed hosts are at high risk.

Implications:

• This highlights the importance of considering disseminated histoplasmosis in transplant recipients.
• Early diagnosis through bone marrow examination can improve patient outcomes.
• Transplant centers should be aware of this risk in patients from endemic regions.