The Progressive Pligmologist: Case Study December 2025

Our patient is a 45 year old male who presented to our clinic with a left forearm ulcer that persisted despite typical management with topical agents.  When he came to be evaluated, he reported that the appearance had prompted use of silver nitrate, aquacel silver, and hydrofera blue classic with no improvement, and site continued to expand. Due to its unusual appearance, a malignant process had been proposed as the cause of the lesion, and biopsy was considered.

 On further questioning, he did report a past medical history of relapsing multiple sclerosis which had been managed with use of Ocrevus. Ocrelisumab, an infused biologic that targets CD20 on B cells, is notable for putting receipients at risk of particular infections, including invasive fungal disease. With this in mind, further workup demonstrated a positive urinary titer for histoplasmosis, and a diagnosis of nondisseminated cutaneous histoplasmosis was made. Once ocrevus was discontinued and patient was initiated on fluconazole for six months, the site completely remitted.