Gastrointestinal presentation of disseminated histoplasmosiin a transplant recipient

histoplasmosis is a clinically relevant fungal infection in immunosuppressed patients, in whom it may present as a serious disease. we describe the case of a renal transplant recipient who presented with malaise, dry cough, severe weight loss, abdominal pain and watery diarrhoea. the laboratory workup revealed anaemia and elevated c reactive protein. chest x-ray showed bilateral reticulonodular infiltrates, and computed tomography scan of the chest and abdomen revealed diffuse thickening of the inter- and intralobular septs, suggestive of lymphangitic infiltration. the abdomen had multiple lymphadenopathies along the mesenteric vessels. endoscopic evaluation disclosed disseminated ulcers throughout the entire gastrointestinal tract, and biopsies confirmed the diagnosis of histoplasmosis. despite adequate treatment with liposomal amphotericin b, the patient had a fatal outcome. we describe this case because of the rarity of gastrointestinal presentation in the context of disseminated histoplasmosis, and we also speculate about the transmission through the allograft. it highlights the importance of considering this once geographically limited disease in challenging cases, even in non-endemic areas