Tongue necrosis as a manifestation of immune dysfunction: A complex case of systemic lupus erythematosus, histoplasmosis, and macrophage activation syndrome

Immune dysfunction can manifest in unexpected ways. We present the case of a patient with systemic lupus erythematosus (SLE) in whom the first sign of disseminated histoplasmosis and consequent macrophage activation syndrome (MAS) was tongue necrosis. In those with immune dysfunction, a high index of clinical suspicion for atypical infections is warranted.