P-109: GASTROINTESTINAL HISTOPLASMOSIS IN A PATIENT WITH MULTIPLE MYELOMA AFTER AUTOLOGOUS BONE MARROW TRANSPLANTATION: ORAL ULCER DIFFERENTIAL DIAGNOSIS. CASE REPORT.

Introduction: Introduction/

Background:
Histoplasmosis is an opportunistic fungal disease caused by Histoplasma capsulate. In immunocompetent patients, it is generally asymptomatic. However, in immunocompromised host it can cause different clinical subtypes as pulmonary, disseminated, or gastrointestinal presentation. Immunocompromised patients, such as those with hematological malignancies, can be infected by Histoplasmosis and the prognostic is poor if several organs are affected. The incidence of histoplasmosis after HSCT is believed to be rare. There are few reports in the literature of histoplasmosis infection in Hematologic patients in patients who underwent autologous bone marrow transplantation (BMT) has been described. Mainly in non-endemic areas of the disease. The purpose of this case report is to highlight the importance of histoplasmosis in the differential diagnosis of those patients with a clinical history oral ulcers and non bacterial diarrhea. Outside endemic areas it might be under diagnosed even in immunocompromised patients so it could be a challenging diagnosis. The present case highlights the unusual, but possible, clinical scenario of Histoplasmosis gastrointestinal involvement after autologous stem cell transplant in a Myeloma patient.





Methods: NA

Results:

Case: P.H.D.S.M, male, 52 years old, with light chain (Kappa) multiple myeloma, ISS3 B treated with Daratumumab, Bortezomib, Lenalidomide and dexamethasone (DVD) 6 cycles and Autologous Stem cell transplant. On the 65th day after transplant he presented diarrhea, fever and multiple shallow oral mucosal ulcers, with a yellowish fibrinopurulent background with painless perilesional hyperemia. It was suspected to be Cytomegalovirus infection (CMV), despite negative quantitative PCR test. Oral and GI biopsy were performed and he was started on venous ganciclovir treatment. The oral biopsy result showed no viral inclusion but ulcered lesion infiltrated by neutrophils, lymphocytes and macrophages. The Macrophage cytoplasm showed many roundish structures compatible with Histoplasma Capsulatum. Gancyclovir was changed to Liposomal Amphotericin B. The patient improved diarrhea resolved and oral ulcers healed.



Conclusions:

Conclusion: We report a case of gastrointestinal histoplasmosis infection in a Myeloma patient after autologous stem cell transplant and DVD treatment. Thus, we recall the attention for the importance of histoplasmosis suspicion as a differential diagnosis in patients undergoing stem cell transplant and possibly the impact of new immunotherapies for MM treatment.