title: A case of disseminated sporotrichosis treated with prednisolone, immunosuppressants, and tocilizumab under the diagnosis of rheumatoid arthritis.
abstract: We encountered a disseminated sporotrichosis patient with polyarthritis and progressive skin ulcers, who had been previously treated with prednisolone, tocilizmab, tacrolims, and cyclophosphamide under the diagnosis of rheumatoid arthritis in another hospital. Making the diagnosis of leukocytoclasticvasculitis based on the clinical observation of skin ulcers, we intensified immunosuppressive therapy. Unfortunately, the patient developed septic shock. Blood culture revealed that the pathogenic organism was sporothrixschenckii. Any case of intractable arthritis or skin ulcers, which does not improve, despite adequate immunosuppressive therapy, is likely to be suspicious of sporotrichosis.
authors.affiliation: Department of Internal Medicine, University of Tsukuba, Japan.
authors.forename: Tetsuto
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Yohei
authors.initials: Y
authors.lastname: Takano
authors.forename: Naoto
authors.initials: N
authors.lastname: Umeda
authors.forename: Mizue
authors.initials: M
authors.lastname: Goto
authors.forename: Masanobu
authors.initials: M
authors.lastname: Horikoshi
authors.forename: Taichi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Goto
authors.forename: Isao
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sumida
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001170:Arthritis, Infectious / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D011239:Prednisolone / Q000009:adverse effects*; D012772:Shock, Septic / Q000209:etiology; D013174:Sporotrichosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D011239:Prednisolone; C502936:tocilizumab