Association between healthcare professionals' perceptions of hospital attitudes towards workplace violence and the prevalence of workplace violence: a nationwide cross-sectional survey in China.

Histoplasmosis is caused by and is usually acquired via inhalation, leading to pulmonary disease. Primary cutaneous histoplasmosis (PCH) is rare, resulting from direct cutaneous inoculation. Although described more often in immunocompetent hosts, it can occur in immunosuppressed patients and be easily overlooked. Tumour necrosis factor-α (TNF-α) inhibitors and corticosteroids increase susceptibility to endemic mycoses. Misdiagnosis as bacterial cellulitis can delay appropriate treatment. A woman in her 60s with rheumatoid arthritis (RA) (on infliximab and prednisone), type 2 diabetes mellitus, hypertension and interstitial lung disease presented with approximately 2 months of progressive swelling and erythema of the left hand and wrist and non-painful nodular/indurated lesions on the left forearm (). She had received a prior course of oral cephalexin without improvement. Approximately 8 months earlier, she experienced a similar episode treated as cellulitis with prolonged antibiotics; symptoms never fully resolved. She denied trauma, aquatic exposures or pet contact but reported frequent gardening. Medications included methylprednisolone 16 mg/day, leflunomide, infliximab (last infusion approximately 1 month prior to presentation), metformin, fenofibrate and losartan. She was born in Guyana, moved to the USA in 1983, and previously worked as a farmer. She denied tobacco, alcohol or drug use and had no known tuberculosis exposure. On examination, she was afebrile with stable vital signs. Dermatological evaluation revealed a well-demarcated red-to-violaceous indurated plaque on the left forearm with erythema extending to the wrist and surrounding oedema but no regional lymphadenopathy (). Musculoskeletal exam showed mild synovitis of the left wrist and third metacarpophalangeal joint.