Coccidioidal synovitis of the knee.

Area of Science:

• Infectious Diseases
• Rheumatology
• Orthopedic Surgery

Background:

• Coccidioidal synovitis of the knee is a challenging joint infection.
• Treatment outcomes for coccidioidal synovitis can vary, with some patients experiencing persistent or recurrent disease despite standard antifungal therapy.
• The role of surgical intervention in conjunction with antifungal treatment remains an area of interest.

Purpose of the Study:

• To evaluate the efficacy of synovectomy combined with limited amphotericin B therapy in treating coccidioidal synovitis of the knee.
• To assess the long-term outcomes of this combined therapeutic approach.
• To determine if synovectomy can reduce the required dosage and duration of amphotericin B therapy.

Main Methods:

• Case series describing four patients with documented coccidioidal synovitis of the knee joint.
• Patients received synovectomy and limited parenteral amphotericin B therapy.
• Intra-articular amphotericin B administration was also utilized in some cases.
• Long-term follow-up (two to seven years) was conducted to assess for evidence of active synovial infection.

Main Results:

• None of the four patients showed evidence of active synovial infection at two to seven years post-treatment.
• Two patients had no prior diagnosis of coccidioidomycosis before developing synovitis.
• Two patients had active disease despite previous courses of amphotericin B for disseminated disease and synovitis.
• Limited parenteral amphotericin B therapy was sufficient following synovectomy.

Conclusions:

• Synovectomy is a crucial component of optimal therapy for coccidioidal synovitis of the knee.
• Combining synovectomy with limited parenteral amphotericin B therapy can lead to successful long-term outcomes.
• Intra-articular amphotericin B administration is also recommended when feasible.