Widespread dermatophytosis after combined immunosuppressive therapy in a patient with COVID-19

       Mycotic diseases of human skin are frequently diagnosed reaching 20–25% of the population prevalence. The leading factor in the mycotic prevalence is the high survival rate of fungi in various environmental conditions. Up to 30 genera of fungi constantly live on human skin and mucous membranes. This constant balance of their presence on the body and interaction with it is called a mycobiome. If the balance between it and the macroorganism is disturbed, the reproduction of fungi begins and mycotic skin lesions develop.

The study included the patient V. 75 years old, who came in with complaints of widespread rashes on the skin of the body and limbs accompanied by peeling after a COVID-19 infection. Microscopy revealed mycelium of pathogenic fungi. The patient received systemic and topical antifungal therapy until the end of hospitalization. He continued to receive terbinafine on an outpatient basis in combination with a topical antimycotic after discharge. Short review on baricitinib and levilimab is presented. According to the results of the study, a 60–70% regression of the skin process was achieved after 2 weeks at discharge. One month later a complete regression of the skin process was achieved due to the therapy.

The use of the combination of janus-kinase inhibitors with biological drugs and systemic glucocorticosteroids in COVID-19 patients has a powerful immunosuppressive effect on the body. It leads to the development of a common fungal skin lesion, which was observed in our patient.