A Rare Case of Blastomycosis in a Psoriasis Patient Treated With Ustekinumab (Stelara)
Abstract
Psoriasis is a chronic inflammatory skin condition mediated by T-helper 1 (Th1) and T-helper 17 (Th17) cytokines, including interleukin (IL)-12, IL-23, IL-17, and tumor necrosis factor alpha (TNF-α). Ustekinumab, a human monoclonal antibody against the p40 subunit of IL-12/23, has revolutionized treatment of moderate to severe psoriasis but carries a risk of opportunistic infections due to impaired cell-mediated immunity. We describe a 54-year-old man from Kentucky with type 2 diabetes and chronic sinusitis, receiving ustekinumab for 1 year for plaque psoriasis. He presented with recurrent pneumonia unresponsive to multiple courses of amoxicillin-clavulanate, azithromycin, and levofloxacin. Chest imaging consistently demonstrated left lower lobe airspace opacities, initially attributed to nonresolving bacterial pneumonia or possible malignancy. On bronchoscopy with bronchoalveolar lavage, scattered broad-based budding yeast were visualized, and culture confirmed Blastomyces dermatitidis. The patient was initiated on oral itraconazole, resulting in symptomatic relief and gradual radiographic resolution over 6 months of follow-up. Although pulmonary blastomycosis is rare (1-2 cases per 100,000 in endemic areas), clinicians should maintain a high index of suspicion for endemic mycoses in immunosuppressed patients on biologic therapies presenting with persistent pulmonary infiltrates. Early invasive diagnostics and targeted antifungal therapy are critical to prevent morbidity…
Read the paper
Related studies
- Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
- Levofloxacin-Induced Tendon Rupture: A Case Report and Review of the Literature
- Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)
- Neuroprotective Effects of Epicatechin against Oxidative Stress-Induced Cognitive Impairment: A Systematic Review and Meta-Analysis
- Quality evaluation and in vitro interaction studies between levofloxacin 250mg and diclofenac sodium 50mg tablets
- Molecular Epidemiology of mcr-1 -Positive Polymyxin B-Resistant Escherichia coli Producing Extended-Spectrum β-Lactamase (ESBL) in a Tertiary Hospital in Shandong, China
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.