The globe has not yet recovered from Coronavirus disease 2019 (COVID-19). The infection with the virus and its treatment can lead to a state of immunological aberration predisposing to many infections. Here we present this patient who was treated with steroids during COVID but later developed mucocutaneous nodular lesions and arthritis. This was initially treated as an autoimmune disease which was eventually diagnosed to be systemic histoplasmosis. There are few case reports on post-COVID histoplasmosis in HIV patients. However, there is a paucity of literature on non-HIV patients. We report this case as the treating physician and rheumatologist must be cognizant of the atypical infections which can mimic an autoimmune disease. As management differs in both, awareness can avoid morbidity for the patient.
Pachymeningitis is a rare manifestation of granulomatosis with polyangiitis (GPA), and there is a paucity of literature regarding the efficiency of rituximab (RTX) in such cases. We present a woman in her early 50s with GPA who initially responded adequately to conventional therapy. However, the treatment course was complicated by pulmonary cryptococcosis. The patient later developed non-infectious pachymeningitis, which failed to respond to steroids and methotrexate. However, using RTX upfront led to good clinical response and radiological resolution.
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