Persistent fever in a pediatric renal transplant patient: Answers

  • Neziha Celebi
  • Jesus G. Vallejo
  • Olive S. Eckstein
  • Jessica Geer
  • Jyotinder N. Punia
  • Ewa Elenberg
Clinical Quiz


  1. 1.

    Figure 1 Bone marrow aspirate (MSN stain) with budding yeast forms. Figure 2. Bone marrow aspirate smear with a rare histiocyte showing hemophagocytosis.

  2. 2.

    Fungal culture and fungal antigens (blood, bone marrow, spinal fluid)

  3. 3.

    Final diagnosis is hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis.


Clinical results

Bone marrow biopsy showed presence of intracellular yeast forms along with rare histiocytes showing hemophagocytosis.

Histoplasma serum Ag was positive and fungal blood and bone marrow cultures grew H. capsulatum. MRI of the brain with contrast did not show any evidence of fungal infection.

Full body PET-CT was performed and showed multiple enlarged lymph nodes throughout the chest and abdomen, as well as splenomegaly. Diagnostic lumbar puncture was performed and cultures were sent, including fungal culture. Cerebrospinal fluid Histoplasma serum Ag was 0.96 (positive).

Additional studies for evaluating HLH were sent: SolIL2R was...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© IPNA 2018

Authors and Affiliations

  • Neziha Celebi
    • 1
  • Jesus G. Vallejo
    • 2
  • Olive S. Eckstein
    • 3
  • Jessica Geer
    • 1
  • Jyotinder N. Punia
    • 4
  • Ewa Elenberg
    • 1
  1. 1.Section of Pediatric Nephrology, Department of PediatricsBaylor College of Medicine and Texas Children’s HospitalHoustonUSA
  2. 2.Section of Pediatric Infectious Diseases, Department of PediatricsBaylor College of Medicine and Texas Children’s HospitalHoustonUSA
  3. 3.Section of Pediatric Hematology/Oncology, Department of PediatricsBaylor College of Medicine and Texas Children’s HospitalHoustonUSA
  4. 4.Department of Pathology and ImmunologyBaylor College of Medicine and Texas Children’s HospitalHoustonUSA

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