CLINICAL-EVIDENCE OF SPINAL AND CEREBRAL HISTOPLASMOSIS 20 YEARS AFTER RENAL-TRANSPLANTATION

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically a pparent. We report an unusual case of a renal transplant recipient wit h long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Find ings of CSF examination were normal, but stereotaxic biopsies of his c ortical lesions demonstrated yeast forms and cultures of biopsy specim ens yielded H. capsulatum. Clinical defects referable to both the cort ical and spinal lesions decreased in severity after the patient receiv ed antifungal therapy. Our case illustrates that disseminated histopla smosis can present in myriad ways and that widespread disease in the C NS can be occult in immunocompromised patients.