{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T15:26:02Z","timestamp":1777476362437,"version":"3.51.4"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,11,1]]},"abstract":"<jats:p>Blastomyces\u2008dermatitidis is a dimorphic fungus endemic to much of North America, particularly the soils of the midwestern and southeastern United States. Human infection typically occurs through inhalation of airborne conidia, which can be followed occasionally by dissemination to the skin, bone, genitourinary system, and central nervous system. A hallmark of the pathogen is that it can cause disease in both immunocompetent and immunosuppressed populations. Blastomycosis is rare in pediatric patients, with cutaneous manifestations occurring even less frequently. Here, we report the case of a 9-year-old boy on iatrogenic immunosuppression with infliximab and methotrexate for juvenile idiopathic arthritis who presented with a nonhealing, indurated plaque of his right ear with significant superficial yellow crusting in the absence of constitutional symptoms. After failing a prolonged course of topical and oral antibiotic therapy, biopsy and tissue culture revealed Blastomyces dermatitidis infection. The area cleared after treatment with oral fluconazole and withdrawal of infliximab. To our knowledge, this is the first report of a pediatric patient developing an infection with B\u00a0dermatitidis after initiation of therapy with a tumor necrosis factor-\u03b1 inhibitor. This case also highlights an unusual morphology of cutaneous blastomycosis in an iatrogenically immunosuppressed child.<\/jats:p>","DOI":"10.1542\/peds.2015-1675","type":"journal-article","created":{"date-parts":[[2015,10,20]],"date-time":"2015-10-20T12:06:16Z","timestamp":1445342776000},"page":"e1386-e1389","source":"Crossref","is-referenced-by-count":14,"title":["Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab"],"prefix":"10.1542","volume":"136","author":[{"given":"Robert J.","family":"Smith","sequence":"first","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus D.","family":"Boos","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, and"},{"name":"Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"},{"name":"Section of Dermatology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon M.","family":"Burnham","sequence":"additional","affiliation":[{"name":"Divisions of Rheumatology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen M.","family":"McKay","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, and The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Kim","sequence":"additional","affiliation":[{"name":"Infectious Disease, Department of Pediatrics, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda","family":"Jen","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, and"},{"name":"Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"},{"name":"Section of Dermatology,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2015,11,1]]},"reference":[{"issue":"8","key":"2021120906094804200_B1","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1365-4632.2008.03732.x","article-title":"Cutaneous blastomycosis: a diagnostic challenge.","volume":"47","author":"Mason","year":"2008","journal-title":"Int J Dermatol"},{"issue":"3","key":"2021120906094804200_B2","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1053\/adpa.2002.34575","article-title":"Blastomycosis: the great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients.","volume":"6","author":"Lemos","year":"2002","journal-title":"Ann Diagn Pathol"},{"issue":"2","key":"2021120906094804200_B3","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1128\/CMR.00056-09","article-title":"Clinical and laboratory update on blastomycosis.","volume":"23","author":"Saccente","year":"2010","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"2021120906094804200_B4","first-page":"AB85","article-title":"Current and emerging tests for diagnosis of cutaneous blastomycosis.","volume":"62","author":"Adams","year":"2010","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"2021120906094804200_B5","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1155\/2009\/824101","article-title":"Risk factors for acquisition of endemic blastomycosis.","volume":"20","author":"Choptiany","year":"2009","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2021120906094804200_B6","unstructured":"US Food and Drug Association. Safety Information\u2014Remicade (infliximab). Updated January 2015. Available at: http:\/\/www.fda.gov\/safety\/medwatch\/safetyinformation\/ucm247032.htm. Accessed March 9, 2015"},{"issue":"9","key":"2021120906094804200_B7","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1093\/cid\/cit489","article-title":"Infections in children and adolescents with juvenile idiopathic arthritis and inflammatory bowel disease treated with tumor necrosis factor-\u03b1 inhibitors: systematic review of the literature.","volume":"57","author":"Toussi","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2021120906094804200_B8","first-page":"AB130","article-title":"Cutaneous blastomycosis in the absence of active pulmonary disease.","volume":"56","author":"Stephens","year":"2007","journal-title":"J Am Acad Dermatol"},{"issue":"12","key":"2021120906094804200_B9","first-page":"719","article-title":"Cutaneous blastomycosis, an unusual presentation.","volume":"78","author":"Turner","year":"1980","journal-title":"J Ky Med Assoc"},{"issue":"10","key":"2021120906094804200_B10","doi-asserted-by":"crossref","first-page":"E44","DOI":"10.1086\/339957","article-title":"Cutaneous inoculation blastomycosis.","volume":"34","author":"Gray","year":"2002","journal-title":"Clin Infect Dis"},{"issue":"5","key":"2021120906094804200_B11","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.medmal.2006.01.006","article-title":"La blastomycose cutan\u00e9e: trois cas.","volume":"36","author":"Ferchichi","year":"2006","journal-title":"Med Mal Infect"},{"issue":"4","key":"2021120906094804200_B12","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1001\/archderm.1971.04000220066013","article-title":"Primary cutaneous blastomycosis.","volume":"104","author":"Landay","year":"1971","journal-title":"Arch Dermatol"},{"issue":"3","key":"2021120906094804200_B13","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1093\/clinids\/22.3.496","article-title":"Blastomycosis in children.","volume":"22","author":"Schutze","year":"1996","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2021120906094804200_B14","first-page":"235","article-title":"Blastomycosis in children.","volume":"12","author":"Varkey","year":"1997","journal-title":"Semin Respir Infect"},{"key":"2021120906094804200_B15","first-page":"AB105","article-title":"Cutaneous blastomycosis: a case report and review of the literature.","volume":"64","author":"Kline","year":"2011","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"2021120906094804200_B16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/00006454-198307000-00011","article-title":"Systemic blastomycosis in children.","volume":"2","author":"Steele","year":"1983","journal-title":"Pediatr Infect Dis"},{"issue":"6","key":"2021120906094804200_B17","first-page":"627","article-title":"Blastomycosis in children and adolescents: a 30-year experience from Manitoba.","volume":"49","author":"Fanella","year":"2011","journal-title":"Med Mycol"},{"issue":"1","key":"2021120906094804200_B18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/j.1525-1470.2012.01799.x","article-title":"Cutaneous and disseminated blastomycosis: a pediatric case series.","volume":"30","author":"Brick","year":"2013","journal-title":"Pediatr Dermatol"},{"issue":"11","key":"2021120906094804200_B19","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.2165\/00003495-200969110-00002","article-title":"Endemic fungal infections in patients receiving tumour necrosis factor-alpha inhibitor therapy.","volume":"69","author":"Smith","year":"2009","journal-title":"Drugs"},{"issue":"1","key":"2021120906094804200_B20","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.rdc.2009.03.009","article-title":"Infectious complications of biologic agents.","volume":"35","author":"Martin-Mola","year":"2009","journal-title":"Rheum Dis Clin North Am"},{"issue":"11","key":"2021120906094804200_B21","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1097\/MIB.0b013e31828f1fba","article-title":"Endemic fungal infections in inflammatory bowel disease associated with anti-TNF antibody therapy.","volume":"19","author":"Ordonez","year":"2013","journal-title":"Inflamm Bowel Dis"},{"issue":"2","key":"2021120906094804200_B22","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1111\/codi.12050","article-title":"Infliximab-associated Blastomycosis dermatitidis in treatment of ulcerative colitis.","volume":"15","author":"McCann","year":"2013","journal-title":"Colorectal Dis"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/5\/e1386\/1093332\/peds_2015-1675.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/5\/e1386\/1093332\/peds_2015-1675.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T00:24:19Z","timestamp":1639095859000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/136\/5\/e1386\/33759\/Atypical-Cutaneous-Blastomycosis-in-a-Child-With"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,1]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2015,11,1]]},"published-print":{"date-parts":[[2015,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2015-1675","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,1]]}}}