Cutaneous histoplasmosis as a complication after anti-TNF use - Case report

Abstract

Anti-TNF agents are effective in the treatment of psoriasis. However, they render individuals more susceptible to infections. We report an atypical case of histoplasmosis in an immunosuppressed patient due to anti- TNF therapy. A patient who used anti-TNF for the treatment of psoriasis had had a lesion on the right eyebrow since discontinuation of the medication. The diagnostic hypothesis was basal cell carcinoma, but the histopathological examination was compatible with histoplasmosis.

Dermoscopy in disseminated sporotrichosis

“…Dermatoscopic features of cutaneous leishmaniasis include generalized erythema, yellow tears, white star-burst-like pattern and increased vascularity 4 while those of blastomycosis are thick, overlapping papillomatous structures with a pink vascular hue, haemorrhagic crusting and irregular vessels. 5 Dermatoscopic features of histoplasmosis are scaling and peripheral arborizing telangiectasias, 6 while those of cutaneous cryptococcosis are structureless yellowish halo, multiple vessels of different sizes and white structureless areas. 1 Generalized erythema, yellowish structureless area, arborizing telangiectasias and white scar-like areas appear to be common dermoscopic features of neutrophilic-rich granulomatous inflammation including leishmaniasis and deep mycosis.…”

“…Yellowish structureless areas represent granulomatous component of the lesion; arborizing telangiectasias reflects neo-angiogenesis, pustules represent neutrophilic micro-abscesses, and white irregular lines represent areas of scarring and fibrosis. Zattar et al 6 Cutaneous histoplasmosis Anti-TNF-therapy Scaling and peripheral arborizing telangiectasias (information on magnification and polarized/non-polarized mode-not given)…”

Primary Cutaneous Histoplasmosis in an Immunocompetent Individual: A Rare Disease from a Dermoscopic Perspective

“…Histoplasmosis dermoscopy has previously been reported in only one case report. [ 2 ] In this report, dermoscopy showed arborizing telangiectasias and superficial scaling. In our case, we report additional distinctive dermoscopic features other than findings reported earlier, that is, yellowish orange area, yellow dots, perifollicular cast, and linear vessels and we have correlated them with histopathological findings.…”

Chronic Ulcer on the Tongue as a Manifestation of Histoplasmosis During Anti-tumor Necrosis Factor-Alpha (TNF-⍺) Inhibitor Therapy for Psoriasis

“…TNF-α plays a role in the host defense against Histoplasma capsulatum [ 2 ]. Reactivation of latent histoplasmosis and subsequent dissemination following treatment with TNF-α inhibitors including adalimumab have been described [ 6 , 7 ]. In our patient, the calcified pulmonary granulomas on CXR indicate prior exposure to Histoplasma , while the tongue ulceration reflects disseminated disease that was previously asymptomatic until immunosuppression following treatment of psoriasis.…”