Sex: M
Vaccine: COVID19
Symptoms: Histoplasmosis, Investigation, Myelodysplastic syndrome, SARS-CoV-2 test, Transient ischaemic attack
Clinical narrative: This spontaneous report was received from literature: DELAYED DIAGNOSIS OF HISTOPLASMOSIS IN A PATIENT WITH A PROSTHETIC AORTIC VALVE. JACC. 2022 MAR 08; 79/9 Supplement A. This report concerned a 50 year old male of an unspecified race and ethnic origin. The patient's height, and weight were not reported. The patient's concurrent conditions included: congenital aortic valve disease (The patient had post bioprosthetic AV replacement (AVR) in 2014). The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, post vaccination the patient was presented with 6 months of flu-like illness, pancytopenia, and suspected transient ischemic attack. Laboratory data (dates unspecified) included: COVID-19 PCR test (NR: not provided) Negative. From detailed workup laboratory investigations revealed myelodysplastic syndrome and positive urine histoplasmosis antigen. Chest computed tomographic angiography (CTA) provided demonstrated a 16x16 mm left lower lobe pulmonary nodule with central cavitation suspicious for pulmonary histoplasmosis. Transesophageal echocardiography (TEE) showed bulky thickening of the prosthetic leaflets with suspected vegetation causing severe prosthetic aortic stenosis. Head and neck CTA showed no mycotic aneurysms. Intraoperative findings included a very large vegetation with near-total obstruction of the aortic valve and circumferential necrotic tissue of the aortic root. Treatment medications (dates unspecified) included: Amphotericin B and underwent redo AV replacement. The authors concluded that despite its rare incidence, histoplasmosis should remain on the differential for infective endocarditis in patients presenting with systemic illness and prosthetic valves. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the histoplasmosis, myelodysplastic syndrome, suspected transient ischemic attack and infective endocarditis with histoplasmosis was not reported. This report was serious (Other Medically Important Condition). Sender's Comments: V0:20220409335-Covid-19 vaccine ad26.cov2.s-Myelodysplastic syndrome, Suspected transient ischemic attack. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). Therefore, this event(s) is considered unassessable. 20220409335-Covid-19 vaccine ad26.cov2.s-Histoplasmosis, Infective endocarditis with histoplasmosis. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: UNDERLYING DISEASE (Myelodysplastic syndrome). Therefore, this event(s) is considered not related.