{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:12:01Z","timestamp":1790241121223,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Psoriasis is a chronic inflammatory skin condition mediated by T\u2010helper 1 (Th1) and T\u2010helper 17 (Th17) cytokines, including interleukin (IL)\u201012, IL\u201023, IL\u201017, and tumor necrosis factor alpha (TNF\u2010\u03b1). Ustekinumab, a human monoclonal antibody against the p40 subunit of IL\u201012\/23, has revolutionized treatment of moderate to severe psoriasis but carries a risk of opportunistic infections due to impaired cell\u2010mediated immunity. We describe a 54\u2010year\u2010old man from Kentucky with type 2 diabetes and chronic sinusitis, receiving ustekinumab for 1\u2009year for plaque psoriasis. He presented with recurrent pneumonia unresponsive to multiple courses of amoxicillin\u2010clavulanate, azithromycin, and levofloxacin. Chest imaging consistently demonstrated left lower lobe airspace opacities, initially attributed to nonresolving bacterial pneumonia or possible malignancy. On bronchoscopy with bronchoalveolar lavage, scattered broad\u2010based budding yeast were visualized, and culture confirmed\n                    <jats:italic>Blastomyces dermatitidis<\/jats:italic>\n                    . The patient was initiated on oral itraconazole, resulting in symptomatic relief and gradual radiographic resolution over 6\u2009months of follow\u2010up. Although pulmonary blastomycosis is rare (1\u20132 cases per 100,000 in endemic areas), clinicians should maintain a high index of suspicion for endemic mycoses in immunosuppressed patients on biologic therapies presenting with persistent pulmonary infiltrates. Early invasive diagnostics and targeted antifungal therapy are critical to prevent morbidity and improve outcomes.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71098","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:43:21Z","timestamp":1759308201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Case of Blastomycosis in a Psoriasis Patient Treated With Ustekinumab (Stelara)"],"prefix":"10.1002","volume":"13","author":[{"given":"Fatima","family":"Ghaffar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Southeast Georgia Health System  Brunswick Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Punjab Medical College  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8599-6861","authenticated-orcid":false,"given":"Masab","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Punjab Medical College  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Noman","family":"Ijaz","sequence":"additional","affiliation":[{"name":"Shaikh Khalifa Bin Zayed Al\u2010Nahyan Medical and Dental College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajjad","family":"Jameel","sequence":"additional","affiliation":[{"name":"UofL Health\u2014Jewish Hospital  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Kumari","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5248-0749","authenticated-orcid":false,"given":"Muhammad Husnain","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Medicine Tentishev Satkynbai Memorial Asian Medical Institute  Kant Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(08)60725\u20104"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis\u20102015\u2010207841"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/588300"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2017.04.006"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.det.2011.08.010"},{"key":"e_1_2_13_7_1","volume-title":"Diagnosis and Treatment of Fungal Infections in Immunocompromised Patients","author":"American Thoracic Society","year":"2025"},{"key":"e_1_2_13_8_1","unstructured":"CDC \u201cData and Statistics on Blastomycosis \u201d (2024) Blastomycosis https:\/\/www.cdc.gov\/blastomycosis\/data\u2010research\/statistics\/index.html."},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myz048"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200906\u2010040AL"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13409"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201906-1185ST"},{"key":"e_1_2_13_13_1","article-title":"Blastomycosis Complicated by Adult Respiratory Distress Syndrome in an Immunocompetent Adult","volume":"16","author":"Furlan A. J.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.273065122"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.921084"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.abd.2023.08.004"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1517\/17425255.2013.794785"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/21505594.2016.1235653"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2017.02.015"},{"issue":"24","key":"e_1_2_13_20_1","first-page":"4368","article-title":"Blastomycosis in China: A Case Report and Literature Review","volume":"124","author":"Zhao T. M.","year":"2011","journal-title":"Chinese Medical Journal"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.11.057"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71098","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71098","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:53:29Z","timestamp":1790240009000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccr3.71098"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71098","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-04-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71098"}}