Central Nervous System Histoplasmosis After Acute COVID-19 in An Adolescent

Central nervous system histoplasmosis is a serious complication of a common endemic mycosis, but it is rare in immunocompetent hosts. SARS-CoV-2 has introduced significant challenges into the healthcare setting with overlapping clinical presentations that may delay the diagnosis of alternative conditions. Additionally, it may lead to immune dysregulation and increase the risk for secondary infections, including invasive fungal diseases. Limited reports have described disseminated histoplasmosis in adults associated with COVID-19, but none have described central nervous system infection or complications in pediatric patients. We report a case of disseminated histoplasmosis involving the central nervous system in a previously healthy 13-year-old male with SARS-CoV-2 infection. An extensive immunological evaluation did not identify an underlying immunodeficiency. We highlight the potential of COVID-19 immune dys-regulation to contribute to the development or progression of invasive fungal disease. [Pediatr Ann. 2024;53(8):e305-e309.].