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Polyarticular blastomycotic arthritis

A Abril1, M D Campbell, V R Cotten

  • 1Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.

The Journal of Rheumatology
|May 23, 1998
PubMed
Summary
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Polyarticular blastomycosis arthritis, a rare fungal infection, can affect multiple joints, lungs, skin, and bones. This case highlights a unique presentation in an elderly woman, emphasizing the need for broad diagnostic considerations.

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.

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  • 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.