Histoplasma in Circulating Blood

To the Editor:—  Since the advent of renal homotransplantation it has become increasingly apparent that a wide variety of viral, bacterial, parasitic, and fungal diseases may develop in recipients of kidney transplants. Although the occurrence of disseminated histoplasmosis has been described in some of these patients,^1,2 the finding of organisms characteristic of Histoplasma capsulatum in the peripheral blood has only rarely been reported.The patient was a 23-year-old white man who was admitted to the hospital, five months after receiving a cadaver renal transplant, because of a four-day history of fever and chills. Study of a Wright-stained peripheral blood smear (Fig 1) revealed intracytoplasmic inclusion bodies characteristic of H capsulatum in many of the white blood cells. Bone marrow aspiration and culture confirmed the diagnosis of histoplasmosis (Fig 2). The patient died of disseminated histoplasmosis involving the brain, lungs, renal allograft, adrenals, bone marrow, and lymph nodes.The finding