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Blastomycosis presenting as monoarticular arthritis. The role of synovial fluid cytology
Abstract:
Joint complaints are common among patients with blastomycosis; however, true arthritis is infrequently documented by synovial fluid analysis. Of 72 individuals with blastomycosis who were patients at the Vanderbilt School of Medicine affiliated hospitals during the period 1957-1983, 6 (8%) had arthritis at presentation. In 5 patients (7%), monoarticular arthritis was the chief complaint leading to hospitalization. Cytologic examination of synovial fluid was performed in 4 patients and demonstrated characteristic organisms each time. Three patients had negative 10% potassium hydroxide smears, and 2 had negative synovial fluid cultures. Blastomycosis should be considered in the differential diagnosis of acute arthritis. In patients with blastomycotic arthritis, cytologic examination of synovial fluid can add to the diagnostic yield of synovial fluid fungal cultures and potassium hydroxide preparations.
Insights
Blastomycosis can cause joint pain, with true arthritis seen in 8% of cases. Synovial fluid cytology is crucial for diagnosing this fungal arthritis when other tests are negative.
Area of Science:
- Mycology
- Rheumatology
- Infectious Diseases
Background:
- Joint complaints are frequent in blastomycosis patients.
- True arthritis is rarely confirmed via synovial fluid analysis in blastomycosis.
Observation:
- Among 72 blastomycosis patients (1957-1983), 6 (8%) presented with arthritis.
- Monoarticular arthritis was the primary complaint for hospitalization in 5 patients (7%).
Findings:
- Synovial fluid cytology identified characteristic organisms in all 4 patients tested.
- Potassium hydroxide smears were negative in 3 patients, and synovial fluid cultures were negative in 2 patients.
Implications:
- Blastomycosis should be included in the differential diagnosis for acute arthritis.
- Synovial fluid cytology enhances diagnostic yield for blastomycotic arthritis, complementing fungal cultures and KOH smears.