Table 4 Reintroduction of immunosuppressive medications and patient histoplasmosis course. Patient history was examined for timing of systemic immunosuppressive medication reinitiation (localized steroid use was not included). Timing of reinitiation was compared with state of histoplasmosis, with “still +” denoting patient had not cleared their histoplasmosis infection based on antigenemia and/or clinical symptoms and “HC for #” indicating how many months it had been since histoplasmosis clearance to beginning the immunosuppressive medication. Median months of follow-up since histoplasmosis clearance was 45.6 (14.7–78.9)

1 JIA

HCQ (10.0, still +), ABA (20.1, still +), Intermittent systemic steroid bursts (5.0 on, still +)

Time to HC: 36.7

2 JIA

MTX (11.2, still +), Leflunomide (61.8, HC for 24.6), Stress/Intermittent steroid bursts (4.3, still +)

Time to HC: 37.2

3 JIA

MTX (22.1, HC for 9.4), ABA (14.2, HC for 1.4), Ustekinumab (46.3, HC for 33.6)

Time to HC: 12.7

4 cSLE

HCQ (0, still +), ABA (14.7, HC for 11.0), Low dose maintenance steroids (0, still +)

Time to HC: 3.7

5 JIA

ABA (4.8, HC for 2.5)

Time to HC: 2.3

6 JIA

HCQ (6.2, still +), MTX (51.2, HC for 30.0), Tocilizumab (21.8, HC for 4.9), Systemic steroids (15.0, HC for 0.6)

Time to HC: 21.2

7 JIA

ABA (25.5, still +)

Antigen positive < LOQ at 18+

8 MCTD

HCQ (0, still +), Low dose stress steroids (0, still +)

Antigen positive and decreasing at 11+

9 JIA

None

Time to HC: 3.3

Summary:

Total patients resuming IM: 8/9 (89), with 6/9 (67 %) DMARD; 6/9 (67 %) biologics; and 5/9 (56 %) systemic steroids

Collective median (range) after diagnosis:

DMARDs 3.1 (0-51.2)

Biologic 17.4 (4.8–25.5)

Corticosteroid 4.3 (0–15.0)

Collective median (range) to IM use from HC:

DMARD Still + (Still + to 9.4)

Biologic 2 (Still + to 11.0)

Corticosteroid all still +

Pt median (range) to HC:

12.7 (2.3–37.2), with 2 still low positives