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We present the case of a patient with systemic lupus erythematosus (SLE) in whom the first sign of disseminated histoplasmosis and consequent macrophage activation syndrome (MAS) was tongue necrosis. In those with immune dysfunction, a high index of clinical suspicion for atypical infections is warranted.<\/jats:p>","DOI":"10.1002\/ccr3.7735","type":"journal-article","created":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T04:10:21Z","timestamp":1689999021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Tongue necrosis as a manifestation of immune dysfunction: A complex case of systemic lupus erythematosus, histoplasmosis, and macrophage activation syndrome"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1625-4844","authenticated-orcid":false,"given":"Madalyn","family":"Walsh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Iowa Hospitals &amp; Clinics  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alick","family":"Feng","sequence":"additional","affiliation":[{"name":"Division of Immunology University of Iowa Hospitals &amp; Clinics  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petar","family":"Lenert","sequence":"additional","affiliation":[{"name":"Division of Immunology University of Iowa Hospitals &amp; Clinics  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharat","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Immunology University of Iowa Hospitals &amp; Clinics  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"e_1_2_11_2_1","article-title":"Tongue necrosis as an initial manifestation of giant cell arteritis: case report and review of the literature","volume":"2015","author":"Zaragoza JR","year":"2015","journal-title":"Case Rep Rheumatol"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.211483."},{"key":"e_1_2_11_4_1","first-page":"1","article-title":"Tongue necrosis secondary to giant cell arteritis: a case report and literature review","volume":"6327437","author":"Siqueira B","year":"2017","journal-title":"Case Rep Med"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1179547619857690"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2006.11.027"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2011.11.008"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2014.09.012"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mycmed.2018.06.004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.12058"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/1305-7456.110197."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1052-5149(03)00039-x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.50.10.869."},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.1997.2270840.x"},{"issue":"5","key":"e_1_2_11_15_1","first-page":"334","article-title":"N\u00e9crose linguale apr\u00e8s radioth\u00e9rapie. 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