Abstract :
Tofacitinib, a Janus kinase (JAK) inhibitor, is increasingly prescribed for autoimmune disorders such as rheumatoid arthritis (RA). By targeting JAK1 and JAK3, it modulates cytokine-mediated immune responses, thereby suppressing lymphocyte activity. Although effective in controlling inflammation, tofacitinib may heighten the risk of opportunistic infections. Histoplasma capsulatum, a thermally dimorphic fungus, causes histoplasmosis, a disease typically rare in India but now more frequently observed, especially among individuals with compromised immunity, such as those with HIV or receiving immunosuppressive therapies. This report describes a rare case of disseminated histoplasmosis in a 58-year-old patient with rheumatoid arthritis receiving tofacitinib. Tofacitinib was promptly discontinued, and the patient was treated with oral itraconazole (200 mg twice daily), leading to complete resolution of the lesion. This case underscores the importance of considering systemic fungal infections in immunosuppressed patients on JAK inhibitors and highlights the effectiveness of early antifungal intervention and modification of immunosuppressive therapy.
Keyword :
Histoplasmosis, Tofacitinib, Janus Kinase inhibitor, Rheumatoid arthritis, Immunocompromised patients.