Disseminated Histoplasmosis Post-IL6 Inhibitor Use in A COVID-19 Patient

We report a case of a 40-year-old male patient who developed a fever one week after recovering from severe COVID-19 illness that had needed treatment with injectable corticosteroids and Tocilizumab. The patient had had maculopapular lesions on his trunk months before contracting COVID-19, but the skin lesions progressed along with the post-covid fever. Detailed workup and biopsy from skin lesions on the face, trunk, and bone marrow revealed Histoplasmosis. This case highlights the possibility of flaring up of Histoplasmosis in COVID-19 patients who have been treated with immunosuppressants. In our case, the plausible reason for reactivation and growth of Histoplasma may be the suppression of IL6 action by Tocilizumab. It may be prudent to screen patients for Histoplasma and other fungal infections like aspergillus before administering an immune-suppressive regimen in patients with a moderate or severe COVID- 19 illness. Urinary Histoplasma antigen may be used for screening in these patients. J Microbiol Infect Dis 2021; 11(3):170-173.