Case Report: Incidental Finding of COVID-19 Infection after Positron Emission Tomography/CT Imaging in a Patient with a Diagnosis of Histoplasmosis and Recurring Fever

Abstract

This is a case report of a 37-year-old woman evaluated with 18F-fludeoxyglucose (18F-FDG) positron emission computed tomography/CT with recurrent fever after treatment with itraconazole for 6 weeks for histoplasmosis. The examination demonstrated a decrease in the dimensions of the pulmonary opacities previously identified in the left lower lobe and attributed to histoplasmosis. In addition to these pulmonary opacities, increased FDG uptake was also observed in lymph nodes present in the cervical region, mediastinum, left lung hilum, and hepatic hilum. Notably, other pulmonary opacities with ground-glass pattern that were not present in the previous computed tomography were detected in the right lower lobe, with mild 18F-FDG uptake. Nasal swab performed shortly after the examination was positive for COVID-19. In this case, the 18F-FDG positron emission computed tomography/CT study demonstrated findings consistent with active COVID-19 infection coexisting with inflammatory changes associated with histoplasmosis infection.

Testing Practices for Fungal Respiratory Infections and SARS-CoV-2 among Infectious Disease Specialists, United States

“…Our finding that most respondents were not concerned about underdiagnosis of coccidioidomycosis, histoplasmosis, blastomycosis, and cryptococcosis in the context of COVID-19 may be justified by the existence of only a few case reports of such co-infections: 4 histoplasmosis cases in Latin America [5,9,10,14], 2 coccidioidomycosis cases in a highly endemic area of California [4,8], 2 cryptococcosis cases in immunocompromised patients [6,7], and no published reports of blastomycosis. Together with the moderate-tohigh testing frequencies (depending on the disease and geographic area) in this survey, this suggests that the overlap between these fungal infections and COVID-19 may not be widely overlooked by respondents.…”

COVID-19-associated opportunistic infections: a snapshot on the current reports

“…To date, scarce information is available regarding the coinfection of endemic fungal infections with CIVID-19. Histoplasmosis caused by Histoplasma capsulatum was reported in five cases of COVID-19 from Brazil [ 95 – 97 ] and Argentina [ 98 , 99 ] in which three of them were HIV positive as well [ 96 , 98 , 99 ]. All cases had pulmonary infections and two of them developed disseminated histoplasmosis [ 98 , 99 ].…”

Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients

“…Histoplasmosis is mainly associated with COVID-19 patients with AIDS, and there are very few studies on the co-infection of H. capsulatum and COVID-19 [ 27 , 52 ]. Actually, the important findings were all patients of COVID-19 having co-infection of H. capsulatum survived after antifungal treatment with amphotericin B and itraconazole ( Table 3 ) [ 27 , 52 , 53 , 54 , 55 ].…”