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

Main Article Content

Connor R Buechler
Elena Kurland
Jesse Veenstra


tinea corporis, tinea capitis, trichophyton, dermatophytosis, tofacitinib, Janus kinase inhibitor


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.


1. Xeljanz medication guide. United Stated Food and Drug Administration. Updated May, 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/203214s018lbl.pdf. Accessed April 18, 2020.

2. Chen, Y., Gong, F. Y., Li, Z. J., Gong, Z., Zhou, Z., Ma, S. Y., & Gao, X. M. (2017). A study on the risk of fungal infection with tofacitinib (CP-690550), a novel oral agent for rheumatoid arthritis. Scientific reports, 7(1), 1-9.

3. Winthrop, K. L., Park, S. H., Gul, A., Cardiel, M. H., Gomez-Reino, J. J., Tanaka, Y., ... & Riese, R. (2016). Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis. Annals of the rheumatic diseases, 75(6), 1133-1138.

4. Bardazzi, F., Balestri, R., Rech, G., Antonucci, A., & Patrizi, A. (2011). Dermatophytosis during anti‐TNF‐α monoclonal antibody therapy. Mycoses, 54(5), e619-e620.

5. Pirker, I. F., Krane-Nuber, J., Albrich, W. C., Müller, R., & Neumann, T. (2018). Atypical presentation of Pneumocystis jirovecii pneumonia in a patient with rheumatoid arthritis treated with tofacitinib: a case presentation. BMC rheumatology, 2(1), 34.

6. Waheed, I., Dhingani, D., Srinivasan, L., & Fulambarker, A. (2016). Double-Edged Sword: Disseminated Histoplasmosis In Rheumatoid Arthritis Patient On Tofacitinib Therapy. In D48. LUNG INFECTION CASE REPORTS I: FUNGAL INFECTIONS (pp. A7121-A7121). American Thoracic Society.

7. Bachelez, H., Van de Kerkhof, P. C., Strohal, R., Kubanov, A., Valenzuela, F., Lee, J. H., ... & Gupta, P. (2015). Tofacitinib versus etanercept or placebo in moderate-to-severe chronic plaque psoriasis: a phase 3 randomised non-inferiority trial. The Lancet, 386(9993), 552-561.

8. Crispin, M. K., Ko, J. M., Craiglow, B. G., Li, S., Shankar, G., Urban, J. R., ... & Marinkovich, M. P. (2016). Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI insight, 1(15).

9. Craiglow, B. G., & King, B. A. (2015). Tofacitinib citrate for the treatment of vitiligo: a pathogenesis-directed therapy. JAMA dermatology, 151(10), 1110-1112.

10. Levy, L. L., Urban, J., & King, B. A. (2015). Treatment of recalcitrant atopic dermatitis with the oral Janus kinase inhibitor tofacitinib citrate. Journal of the American Academy of Dermatology, 73(3), 395-399.

11. Newland, J. G., & Abdel-Rahman, S. M. (2009). Update on terbinafine with a focus on dermatophytoses. Clinical, cosmetic and investigational dermatology: CCID, 2, 49.