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Disseminated Histoplasma capsulatum infection presenting with panniculitis and focal myositis in rheumatoid arthritis treated with etanercept.
[focal myositis]
We
report
the
case
of
a
patient
with
rheumatoid
arthritis
(
RA
)
on
etanercept
who
presented
with
panniculitis
and
focal
myositis
as
manifestations
of
disseminated
histoplasmosis
.
Systematic
search
of
the
literature
showed
11
additional
case
reports
of
disseminated
histoplasmosis
with
tumour
necrosis
factor
-alpha
(
TNFalpha
)
blockade
therapy
(
infliximab
,
n
=
8
;
etanercept
,
n
=
3
)
.
Although
disseminated
histoplasmosis
may
manifest
with
classical
symptoms
of
fever
and
respiratory
complaints
,
it
may
also
present
atypically
,
such
as
with
panniculitis
and
focal
myositis
.
This
review
illustrates
and
emphasizes
the
importance
of
being
highly
suspicious
for
infection
,
including
by
opportunistic
organisms
,
and
to
exclude
such
process
in
patients
treated
with
a
TNFalpha
inhibitor
when
faced
with
unusual
complications
,
even
when
an
alternative
aetiology
appears
plausible
.
