A Rare Case of Disseminated Histoplasmosis with Oral Manifestations in a Rheumatoid Arthritis Patient Treated with Rituximab Diagnostic and Management Challenges – A Review

Abstract

Disseminated histoplasmosis happens to be a rare complication that rheumatologists come across in their clinical practice. Biologics, mainly tumor necrosis factor blockers, have been mentioned as one of the causative factors in invasive histoplasmosis, and there are few case reports to support that. However, rituximab use has not been reported with histoplasmosis infection frequently. The association of such novel biologic agents with serious infections such as histoplasmosis needs further exploration as timely management and intervention can be life-saving for the patient. We report about a 69-year-old female, diagnosed with rheumatoid arthritis, who was treated with rituximab and subsequently developed disseminated histoplasmosis. She was successfully managed with antifungals. Here, we discuss the latest evidence-based treatment modalities for such patients with special reference to rheumatoid patients on biologic therapy.

Keywords

• biologics; histoplasmosis; rheumatoid arthritis; rituximab