{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:22:58Z","timestamp":1791559378493,"version":"4.3.4"},"reference-count":13,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,29]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    Primary cutaneous histoplasmosis (PCH) is a rare fungal infection, often misdiagnosed due to its polymorphic skin manifestations. We describe a woman in her 60s with rheumatoid arthritis receiving infliximab and long-term prednisone who presented with progressive, non-healing lesions of the left forearm. Initially treated as cellulitis without improvement, further investigation led to a diagnosis of PCH due to\n                    <jats:italic>Histoplasma capsulatum<\/jats:italic>\n                    confirmed by fungal culture. She was treated with systemic antifungal therapy with clinical resolution. This case underscores the importance of considering endemic fungal infections in immunocompromised individuals with persistent skin lesions, the value of early biopsy with cultures and careful management of immunosuppression.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-273695","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:10:30Z","timestamp":1785845430000},"page":"e273695","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed diagnosis of primary cutaneous histoplasmosis in a patient receiving tumour necrosis factor alpha inhibitor therapy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9298-9028","authenticated-orcid":false,"given":"Harika","family":"Kalangi","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Northwell Health, New Hyde Park, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivesh K","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Biological Chemistry and Psychology, Stony Brook University, Stony Brook, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind","family":"El Soufi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Northwell Health, New Hyde Park, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080405101371000_19.8.e273695.1","doi-asserted-by":"publisher","DOI":"10.1086\/521259"},{"key":"2026080405101371000_19.8.e273695.2","doi-asserted-by":"crossref","unstructured":"Mazi PB , Arnold SR , Baddley JW , et al . Management of Histoplasmosis by Infectious Disease Physicians. Open Forum Infect Dis 2022;9. doi:10.1093\/ofid\/ofac313","DOI":"10.1093\/ofid\/ofac313"},{"key":"2026080405101371000_19.8.e273695.3","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00035-19","article-title":"Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies","volume":"33","author":"Davis","year":"2020","journal-title":"Clin Microbiol Rev"},{"key":"2026080405101371000_19.8.e273695.4","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1093\/cid\/ciae444","article-title":"Incidence and Risk Factors for Invasive Fungal Infections in Patients Initiating Tumor Necrosis Factor\u2013Alpha Inhibitors for Inflammatory Bowel Disease and Rheumatoid Arthritis","volume":"80","author":"Hennessee","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026080405101371000_19.8.e273695.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2012.01.004"},{"key":"2026080405101371000_19.8.e273695.6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1439-0507.2000.00563.x"},{"key":"2026080405101371000_19.8.e273695.7","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/cup.12792","article-title":"Cutaneous histoplasmosis with prominent parasitization of epidermal keratinocytes: report of a case","volume":"43","author":"Honarpisheh","year":"2016","journal-title":"J Cutan Pathol"},{"key":"2026080405101371000_19.8.e273695.8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ299"},{"key":"2026080405101371000_19.8.e273695.9","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1007\/s10620-020-06181-x","article-title":"Histoplasmosis in Inflammatory Bowel Disease with Tumor Necrosis Factor-Alpha Inhibitors: Safe to Continue Biologics?","volume":"66","author":"Jansson-Knodell","year":"2021","journal-title":"Dig Dis Sci"},{"key":"2026080405101371000_19.8.e273695.10","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000036450","article-title":"Incidence of histoplasmosis in patients receiving TNF-alpha inhibitors: A systematic review and meta-analysis","volume":"102","author":"Cipolat","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026080405101371000_19.8.e273695.11","doi-asserted-by":"crossref","unstructured":"Edupuganti S , Chirumamilla Y , Upadhyay M , et al . Should Histoplasmosis be Screened for Before Initiation of Tumour Necrosis Factor Alpha Inhibitors? Eur J Case Rep Intern Med 2024;11. doi:10.12890\/2024_004467","DOI":"10.12890\/2024_004467"},{"key":"2026080405101371000_19.8.e273695.12","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1093\/cid\/ciad474","article-title":"Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults","volume":"78","author":"Chastain","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026080405101371000_19.8.e273695.13","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-226621","article-title":"Unusual case of cellulitis due to primary cutaneous histoplasmosis","volume":"11","author":"Paul","year":"2018","journal-title":"BMJ Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:10:37Z","timestamp":1785845437000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-273695"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273695","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}