A case report on a severely ill COVID-19 patient with rapid clearing of chest infiltrates 43 hours after treatment with multiple modalities.

A 44-year-old COVID-19 positive patient was transferred to our hospital with worsening acute hypoxemic respiratory failure. She was admitted to ICU and was started on high flow oxygen. Her CXR showed worsening bilateral infiltrates. In order to prevent her progression from severe to critical disease, we adopted a multiple modality treatment approach, utilizing clinical judgment and most recent publications. She was treated with antibiotics, convalescent plasma, steroids, hydroxychloroquine and self-proning. After 43 hours, her CXR showed rapid clearing of infiltrates and we could discharge her on day three of hospitalization. Previously reported case series on convalescent plasma showed the number of days taken for significant improvement in chest x-ray varied from 4 to 7 days. The rapidity of improvement in this patient is remarkable and could be due to the multiple modality treatment approach.

Variable urine Histoplasma antigen with volume status.

A patient with progressive disseminated histoplasmosis was noted to have an increase in urine Histoplasma antigen level during monitoring of her disease. The patient revealed she had inadequately hydrated, and her urine volume was low and subjectively concentrated. Following hydration, urine antigen was retested and became undetectable.

Vertical Transmission of Histoplasmosis Associated With Anti-Tumor Necrosis Factor Therapy.

Therapeutics blocking the activity of tumor necrosis factor (anti-TNF) are a risk factor for invasive fungal infections; however, infectious risks to infants born to mothers receiving anti-TNF therapy are not well defined. We report a case of vertical transmission of disseminated histoplasmosis in a mother-infant pair exposed to anti-TNF therapy.