An autopsy case of disseminated histoplasmosis probably due to infection from a renal allograft

An autopsy case of a 52-year-old Japanese male, who died of disseminated histoplasmosis, is reported. He had received a cadaveric renal allograft 4 years prior to death. The donor was a 33-year-old American negro male, who had resided in Texas. The patient had been treated with immunosuppressive drugs after renal transplantation, and mycotic pneumonia developed 3 months before death. At autopsy, acute necrotizing lesions composed of histiocytes were observed in the transplanted kidney, lungs, prostate gland and various lymph nodes. Abundant yeast-like fungal elements, measuring 2-5 micron in diameter, were engulfed by the histiocytes, and were identified as Histoplasma capsulatum by the immunoperoxidase method. The transplanted kidney was considered to have been the source of the infection.