Blastomycosis presenting as monarticular arthritis. The role of synovial fluid cytology

Abstract

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis (1). The illness can affect multiple organs including lung, skin, bone, and genito-__.___

Blastomycosis infection of the knee treated with staged total knee arthroplasty

“…While B. dermatitidis is known to affect native knees, these infections are typically low enough in severity that they are treated solely with antifungal therapy [2,8,11]. We did, however, find one documented case of blastomycotic knee arthritis in the literature where the destruction to the joint was significant enough to warrant arthrodesis [12].…”

“…Infection typically occurs when soil-dwelling conidia are aerosolized and inhaled into the lungs where they transition to yeast forms [1,6,7]. Blastomycotic arthritis may occur when joints become infected either by direct extension from locally affected bone or via hematogenous spread [1,2,8]. Patients will frequently co-present with systemic involvement of the lungs or skin although otherwise asymptomatic individuals can present with acute onset monoarticular arthritis [7,[9][10][11].…”

Disseminated blastomycosis presenting as oligoarticular septic arthritis in a 12‐year‐old girl

“…Reports in the literature suggest the synovial fluid leukocyte count may vary from 450 to 100,000/mm 3 with Ͼ70% neutrophils (1,5). Synovial fluid fungal cultures and KOH staining are useful in diagnosis and, when performed, have a diagnostic yield of 82% (11). The definitive diagnosis is made by culture or identification of the organism from tissue samples or fluid (5).…”

“…Joint pain is reported in 11% of patients and 8% have frank arthritis (11). The arthritis is usually monarticular, but a few cases involving multiple joints have been reported (1,2).…”

“…This was the case in our patient. Direct extension of osteomyelitis is a well-recognized cause of blastomycotic arthritis, but hematogenous seeding of the synovial membrane is thought to occur as well (11).…”