{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:40:32Z","timestamp":1785886832158,"version":"3.56.0"},"reference-count":8,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,20]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>A 63-year-old white man with a history of rheumatoid arthritis on adalimumab was admitted to the hospital for left arm swelling and erythema. On physical examination, the patient was afebrile and non-toxic appearing and there was tense oedema of the left forearm. Initial laboratory work was unremarkable except for elevated inflammatory markers. MRI of the arm showed non-specific findings of inflammation. The patient was started on empiric antibiotics but did not improve. Given the patient\u2019s immunosuppression, early consideration was given to fungal or mycobacterial causes. Initial serum fungal studies were negative and the patient was taken for diagnostic local incision and biopsy of the left volar forearm. Grocott\u2019s methenamine silver and periodic acid\u2013Schiff staining revealed fungal organisms resembling <jats:italic>Histoplasma<\/jats:italic> and intraoperative fungal cultures grew <jats:italic>Histoplasma capsulatum<\/jats:italic> confirming the diagnosis. The patient was treated with a 6-month course of itraconazole with improvement in his condition and eventual complete resolution.<\/jats:p>","DOI":"10.1136\/bcr-2018-226621","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e226621","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Unusual case of cellulitis due to primary cutaneous histoplasmosis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9266-4212","authenticated-orcid":false,"given":"Vishesh","family":"Paul","sequence":"first","affiliation":[{"name":"Pulmonary and Critical Care Medicine, Carle Foundation Hospital, Urbana, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S","family":"Kuhlenschmidt","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Illinois College of Medicine, Urbana, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,12,14]]},"reference":[{"key":"2025082722205074000_11.1.e226621.1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2203.151117"},{"key":"2025082722205074000_11.1.e226621.2","first-page":"ED01","article-title":"Primary cutaneous histoplasmosis masquerading as lepromatous leprosy","volume":"11","author":"Bhattacharya","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"2025082722205074000_11.1.e226621.3","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1111\/j.1346-8138.2002.tb00226.x","article-title":"A case of primary cutaneous histoplasmosis in a patient with diabetes and multi-infarct dementia","volume":"29","author":"Krunic","year":"2002","journal-title":"J Dermatol"},{"key":"2025082722205074000_11.1.e226621.4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1439-0507.2000.00563.x"},{"key":"2025082722205074000_11.1.e226621.5","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1590\/1806-9282.62.09.816","article-title":"Primary cutaneous histoplasmosis in an immunocompromised patient with long-standing rheumatoid arthritis","volume":"62","author":"Lise","year":"2016","journal-title":"Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"},{"key":"2025082722205074000_11.1.e226621.6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00673-11"},{"key":"2025082722205074000_11.1.e226621.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir435"},{"key":"2025082722205074000_11.1.e226621.8","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-97-5-680"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bcr-2018-226621","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:20:56Z","timestamp":1756358456000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,14]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bcr-2018-226621"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226621","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}