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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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In vivo Macrophage Imaging Using MR Targeted Contrast Agent for Longitudinal Evaluation of Septic Arthritis
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Coccidioides immitis septic knee arthritis.

Scott A Weisenberg1

  • 1Department of Medicine, New York University School of Medicine, New York, USA.

BMJ Case Reports
|March 15, 2018
PubMed
Summary

Coccidioidomycosis, a fungal infection, can affect joints, causing knee pain and swelling. Effective treatment may require surgical intervention and antifungal medication adjustments.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Rheumatology

Background:

  • Coccidioidomycosis is a systemic fungal infection endemic to arid regions of the Americas.
  • Joint involvement, while uncommon, can occur as a manifestation of disseminated coccidioidomycosis.
  • Diagnosis relies on clinical presentation, serological tests, and microbiological cultures.

Observation:

  • A 78-year-old male presented with isolated right knee pain and swelling.
  • The patient had a history of frequent travel to California's Central Valley, a known endemic area.
  • Initial investigations revealed joint fluid culture positive for Coccidioides species and markedly elevated coccidioidal complement fixation antibody titers.

Findings:

  • Standard treatment with arthroscopic debridement and fluconazole provided insufficient clinical improvement.
Keywords:
bone and joint infectionsdrugs: infectious diseases

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  • Subsequent management involved open debridement and a switch to itraconazole therapy.
  • This revised therapeutic approach led to the successful resolution of the knee infection.

    • Implications:

    • This case highlights the importance of considering endemic fungal infections in patients with unexplained joint pathology.
    • Aggressive surgical management combined with appropriate antifungal therapy may be necessary for refractory cases of coccidioidal arthritis.
    • Early and accurate diagnosis is crucial for effective management and preventing long-term sequelae of fungal arthritis.