Cytomegalovirus and Histoplasma—A Rare Gastrointestinal Coinfection in Post–Renal Transplant Patient

A BSTRACT Histoplasma and Cytomegalovirus coinfection is a rare entity, even among immunocompromised patients, and is rarely described in the literature. This coinfection can present with abdominal pain, loose stools, fever and bleeding per rectum. Colonoscopy typically reveals ulceration and can be mistaken for inflammatory bowel disease, intestinal tuberculosis, or malignancy. Diagnosis can be made through histopathology and confirmed with antigen tests, serology, and culture for Histoplasma, as well as immunohistochemistry and polymerase chain reaction for Cytomegalovirus. Treatment includes a combination of long-term antivirals and antifungals. The prognosis of this coinfection is poor; hence, early diagnosis and appropriate treatment are of paramount importance. There are very few cases of coinfection documented in the literature, this case is the second documented coinfection in a post-transplant patient.