Polyarticular blastomycotic arthritis

Area of Science:

• Mycology
• Infectious Diseases
• Rheumatology

Background:

• Blastomycosis is a fungal infection endemic to North America, typically presenting as pulmonary disease or acute monoarticular septic arthritis.
• Disseminated blastomycosis can involve multiple organ systems, but polyarticular arthritis is exceptionally rare, with only two prior reported cases of sequential joint involvement.

Observation:

• This report details an elderly woman presenting with polyarticular blastomycotic arthritis affecting multiple joints.
• The patient also exhibited concurrent involvement of the lungs, skin, and bone, indicating disseminated disease.
• Blastomyces organism was definitively identified in synovial fluid and skin biopsy specimens.

Findings:

• The case demonstrates an unusual presentation of blastomycosis with simultaneous polyarticular joint involvement.
• Identification of the fungus in synovial fluid confirmed blastomycotic arthritis as the cause of the patient's joint inflammation.
• The patient's condition was managed with surgical drainage and aspiration of affected joints, alongside antimycotic therapy.

Implications:

• This case expands the known spectrum of blastomycosis presentations, particularly concerning joint manifestations.
• It underscores the importance of considering fungal infections like blastomycosis in the differential diagnosis of severe, disseminated arthritis, even in atypical patterns.
• Early and accurate diagnosis through microbiological identification is crucial for effective treatment and management of this rare fungal arthritis.