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Virtual case of the month
Fungal sinusitis in simultaneous pancreas-kidney transplant
  1. Daniel W Santos1,
  2. Henrique Proença1,
  3. Jose O Medina-Pestana1,
  4. Érika B Rangel1,2
  1. 1Nephrology Department, Federal University of São Paulo/Hospital do Rim e Hipertensão, Sao Paulo, SP, Brazil
  2. 2Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  1. Correspondence to Dr Érika B Rangel, Federal University of São Paulo/Hospital do Rim e Hipertensão, São Paulo, SP 04038-002, Brazil; erikabr{at}uol.com.br

https://doi.org/10.1136/jclinpath-2018-205258

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    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

    1. Post-transplant lymphoproliferative disorder

    2. Hyalohyphomycosis (Aspergillosis or Fusariosis)

    3. Adenovirus

    4. Histoplasmosis

    5. Mucormycosis

    The correct answer is after the discussion.

    Discussion

    The differential diagnosis of dry cough, nasal congestion and anosmia …

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    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.