Article Text
Statistics from Altmetric.com
Clinical question
A 56-year-old man was submitted to a simultaneous pancreas-kidney transplant 6 years ago. He received induction therapy with thymoglobulin, and maintenance immunosuppressive regimen consisted of tacrolimus (trough levels 6–8 ng/mL), prednisone and mycophenolate. Pulmonary tuberculosis was treated in the first year post-transplant. He reported cough, nasal congestion, and anosmia for at least 6 months. No fever was documented. Chest CT was normal. Sinus CT showed opacification in the right maxillary and ethmoidal sinuses without bone involvement. A biopsy was taken during endoscopic ethmoidectomy and antrostomy sinus surgery.
Review the high-quality, interactive digital Aperio slides at http://virtualacp.com/JCPCases/jclinpath-2018-205258.R1_1/,http://virtualacp.com/JCPCases/jclinpath-2018-205258.R1_2/, http://virtualacp.com/JCPCases/jclinpath-2018-205258.R1_3/ and consider your diagnosis.
Five differential diagnoses
Post-transplant lymphoproliferative disorder
Hyalohyphomycosis (Aspergillosis or Fusariosis)
Adenovirus
Histoplasmosis
Mucormycosis
The correct answer is after the discussion.
Discussion
The differential diagnosis of dry cough, nasal congestion and anosmia …
Footnotes
Handling editor Iskander Chaudhry.
Contributors DWS: data analysis; writing; HP: data analysis; JOM-P: read manuscript; EBR: study design, data analysis and collection, writing.
Competing interests None declared.
Ethics approval Research Ethics Committee of Federal University of São Paulo.
Provenance and peer review Commissioned; internally peer reviewed.
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.