BMJ Case Reports 2017; doi:10.1136/bcr-2017-222012
  • Rare disease

A 30-year delayed presentation of disseminated histoplasmosis in a heart transplant recipient: diagnostic challenges in a non-endemic area

  1. Tirdad Zangeneh3
  1. 1Department of Infectious diseases, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
  2. 2Division of Hematology-Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
  3. 3Department of Infectious Diseases, The University of Arizona College of Medicine, Tucson, Arizona, USA
  1. Correspondence to Dr Aneela Majeed, amajeed{at}
  • Accepted 30 October 2017
  • Published 8 November 2017


A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy. Work-up revealed bilateral adrenal masses, biopsy showed granulomatous changes consistent with histoplasmosis. The possibility of histoplasmosis was less likely as the patient had no prior history of symptomatic disease and had lived in the endemic area 30 years prior to presentation. Brain biopsy confirmed central nervous system involvement. Amphotericin B was initiated for disseminated disease but his hospital course was complicated by renal failure and new liver hypodensities on follow-up imaging. Acute progressive disseminated histoplasmosis can manifest after decades of initial exposure and should always be in differential diagnosis even in non-endemic areas for prompt diagnosis and better clinical outcome.


  • Contributors Concept and design: AM, VK and AL. Data analysis and interpretation: AM, VK and AL. Drafting article: AM, VK and AL. Critical revision of article: AM and TZ. Approval of article: All authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article