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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)
The correct answer is after the discussion.
The differential diagnosis of dry cough, nasal congestion and anosmia …
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.