Extensive Tinea Associated with Tofacitinib Therapy Masquerading as New-Onset SCLE

Connor R Buechler,Elena Kurland,Jesse Veenstra

doi:10.25251/skin.4.5.13

Abstract

Rheumatoid arthritis is a chronic autoimmune disorder that often requires treatment with immunomodulatory agents, however, such interventions are not without risk of opportunistic infection. Monitoring for such conditions is critical, whereas recognition and treatment can prove challenging at times, as they may manifest with an atypical presentation or masquerade as another condition entirely. We present here a case of extensive tinea corporis with concomitant tinea capitis masquerading as new-onset connective tissue disorder in a patient being treated for rheumatoid arthritis with the Janus kinase inhibitor tofacitinib.

Highlights

Fungi of the genera Microsporum, Trichophyton, and Epidermophyton are frequent colonizers of the epidermis
Tofacitinib is a small-molecule Janus kinase inhibitor that is approved for treatment of adults with rheumatoid arthritis, psoriatic arthritis, or ulcerative colitis who have had inadequate response to or were intolerant of methotrexate.[2]
While infrequent cases of tinea pedis were observed in some clinical trials,[3,4] there have as yet been no reports of more generalized dermatophytosis as a result of tofacitinib therapy

Summary

INTRODUCTION

Fungi of the genera Microsporum, Trichophyton, and Epidermophyton are frequent colonizers of the epidermis. A 71-year-old African American woman presented with an intermittently pruritic rash on the upper body, beginning three months prior She stated that this rash had spread from her stomach to her chest, back, shoulders, and scalp during this time. She denied recent fevers, chills, illnesses, unintentional weight loss, changing or bleeding lesions, or oral lesions. A six-week course of oral terbinafine 250 mg daily resulted in significant reduction in pruritis and normalization of the cutaneous physical findings, with the exception of a mild residual scaling on the scalp which again grew Trichophyton on repeat fungal culture at three-month follow-up.

DISCUSSION

CONCLUSION