Intra-articular Amphotericin B Treatment of Sporothrix schenckii Arthritis

Downs, Nancy J.; Hinthorn, Daniel R.; Mhatre, Vijay R.; Liu, Chien

doi:10.1001/archinte.1989.00390040148035

Cited by 27 publications

(3 citation statements)

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“…SSKI should not be used, and fluconazole (response rate of 38%) is not as effective as itraconazole (response rate of 86%) [19,20,23]. Although intraarticular injection of amphotericin B has been reported as beneficial [24], this use of amphotericin B is not recommended as routine therapy for sporotrichal arthritis.…”

Section: Treatmentmentioning

confidence: 99%

State‐of‐the‐art Clinical Article

1999

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Section: Treatmentmentioning

confidence: 99%

State‐of‐the‐art Clinical Article

1999

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“…The use of amphotericin B, regarded as the most effective medical treatment modality for sporotrichal arthritis, 2,4 , 5,14 is limited by nephorotoxicity and hypokalemia in 70–83% of patients 14 . These systemic side‐effects can be avoided by intra‐articular or intrabursal administration of amphotericin B in monoarticular disease 2,17 . Potassium iodide and ketoconazole, effective in the management of lymphocutaneous sporotrichosis, are ineffective as monotherapy for osteoarticular sporotrichosis 3,4 , 14,15 but successful use of these antifungal drugs in combination with surgery has been reported 5 .…”

Section: Discussionmentioning

confidence: 99%

Disseminated cutaneous sporotrichosis: a marker of osteoarticular sporotrichosis masquerading as gout

et al. 2001

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A 60‐year‐old African man presented with an 8‐week history of skin lesions on the face and abdomen that began as small nodules in the malar area. In addition there was a year‐long history of swellings of the right wrist and knee joints and the dorsum of the left hand (Fig. 1a–d). Two years earlier, he had had total replacement of the left knee joint because of histology‐proven chronic gouty arthritis (Fig. 2a). The joint prosthesis was symptom‐free after surgery. He had sought medical advice for his symptoms, and based on the previous diagnosis of gouty arthritis and hyperuricemia, the joint problems were attributed to underlying gout. He was treated with allopurinol and nonsteroidal anti‐inflammatory drugs, but the arthralgia and swelling did not resolve. The patient, a keen gardener, admitted to heavy daily alcohol consumption. 1 (a) Crusted, hypopigmented atrophic lesion with secondary hypopigmentation in the malar area and chin. (b) Indurated erythematous and subcutaneous nodules on trunk (arrows). (c) Cystic lesions on dorsum of hand (arrowheads). (d) Swelling of right knee joint (arrowheads) 2 (a) Biopsy of left knee demonstrating amorphous, fibrillar material with crystals and foreign body granulomatous reaction (H&E 240×). (b) Granulomatous inflammation and microabscess with Splendore‐Hoeppli phenomenon around fungal yeast (arrow) (H&E 480×) On examination crusted, hypopigmented, atrophic lesions with surrounding hyperpigmentation were present on the face (Fig. 1a) and indurated, erythematous, subcutaneous nodules were identified on the trunk and limbs (Fig. 1b). Roentgenograms revealed lytic lesions in the right femur and fibula, erosion of the right ulnar styloid and an intact prosthesis in the left knee joint. A provisional diagnosis of lupus vulgaris or a deep mycoses with incidental joint pathology such as gout or rheumatoid arthritis was made. The Mantoux skin test, Wasserman reaction, rheumatoid factor, antinuclear factor, and HIV investigations were negative. The serum uric acid level was 0.8 mmol/L (normal: 0.15–0.45) and erythrocyte sedimentation rate was 30 mm/h. Skin biopsies of the face and trunk revealed granulomatous inflammation with microabscess formation and the presence of focal fungal yeast forms surrounded by a Splendore‐Hoeppli phenomenon, confirming cutaneous sporotrichosis (Fig. 2b). Culture of lesional skin on blood agar grew budding yeasts of Sporothrix schenckii at 37 °C. The mold phase was isolated at room temperature (25 °C) on Saboraud's dextrose agar. Subsequently, the cysts on the dorsum of the hand and the left knee joint were biopsied and the joint fluid aspirate was cultured, confirming sporotrichosis. Histopathological assessment of the cysts that were subsequently excised from the dorsum of the hand and right knee joint also confirmed sporotrichosis. There were no features of active gout. A definitive diagnosis of multifocal systemic sporotrichosis was made. Within 8 weeks of commencing treatment with 200 mg itraconazole daily, there was resolution of the cutane...

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“…Amphotericin B, preferably a lipid formulation at 3-5 mg/ kg/day, is the only remaining option. Intra-articular, amphotericin B is not recommended [54]. Even if cure occurs, joint function rarely is recovered.…”

Section: Osteoarticular Sporotrichosismentioning

confidence: 99%

Sporotrichosis

Kauffman¹

2015

Diagnosis and Treatment of Fungal Infections

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Intra-articular Amphotericin B Treatment of Sporothrix schenckii Arthritis

Cited by 27 publications

References 13 publications

State‐of‐the‐art Clinical Article

State‐of‐the‐art Clinical Article

Disseminated cutaneous sporotrichosis: a marker of osteoarticular sporotrichosis masquerading as gout

Sporotrichosis

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