IsolatedSporothrix schenckiiMonoarthritis

Abstract

Sporothrix schenkii sensu lato is a rare cause of arthritis. Its course is indolent with lack of constitutional symptoms resulting in delayed presentation and diagnosis. It is a dimorphic fungus found ubiquitously in sphagnum moss, decaying vegetation, soil, and hay. Inoculation of dirt into the skin and soft tissues and, in rare instances, inhalation of aerosolized conidia from soil and plants can lead to infection. Subacute and chronic involvement of skin and subcutaneous tissues is the most common manifestation of sporotrichosis in immunocompetent hosts. In patients with underlying risk factors (HIV, alcoholism, diabetes mellitus, organ transplant patients, immunosuppressive medications, steroids, and malignancies), it can often have disseminated visceral, osteoarticular, meningeal, and pulmonary involvement. Sporothrical arthritis most commonly infects knee joint followed by hand and wrist joints. A culture of Sporothrix schenkii sensu lato is the gold standard for the diagnosis of sporotrichosis. Itraconazole is the drug of choice for osteoarticular sporotrichosis. We present a case of sporotrichal arthritis in a patient without skin or lymph node involvement who underwent treatment with itraconazole resulting in resolution of his symptoms.

Osteoarticular sporotrichosis in an immunocompetent patient

“…Initial manifestations are tenosynovitis, joint effusion, bursitis, and synovial cyst formation [ 8 ]. The time to diagnosis in our case was 6 months; it seems earlier than this reported in previously cases [ 5 , 9 , 10 ]. Due to this early diagnosis of Sporothrix schenkii infection, there are no extensive destructive changes which occur in the affected joints because of delayed diagnosis.…”

“…The cutaneous and lymphocutaneous forms of sporotrichosis are the most common forms of clinical presentation. Osteoarticular lesions are rare, representing 3–4% of cases [ 5 ], and particularly affect immunocompromised, alcoholic and diabetic patients [ 6 , 7 ]. However, our case has no immunosuppression factor.…”

Epidemiology of Clinical Sporotrichosis in the Americas in the Last Ten Years

“…A total of 48 publications related to sporotrichosis were found in North America [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 1460 patients in total associated with infection caused by species of the genus Sporothrix .…”

“…According to the previous classification, it was found that in Canada, only two case reports were found, one from Ontario and the other from Toronto [ 5 , 6 ]. In the US, 27 reports containing 1 clinical case were found (81.5% S. schenckii , 18.5% Sporothrix spp., S. schenckii complex, and S. schenckii sensu lato ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Of these, seven cases came from California, three from Oklahoma, two cases from Kansas, Texas, Arizona, Minnesota, and Florida, one case from Michigan, Nebraska, Oregon, Pennsylvania, and finally, one case without a specific city or region.…”

“…As for the clinical forms of sporotrichosis, various types have been described, such as the lymphocutaneous, fixed cutaneous, and, as mentioned earlier, the disseminated or hematogenous forms where both organs and tissues can be affected [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The latter is the rarest because the recommended antifungal regimens are usually effective; however, in patients with alterations in cellular immunity, these infections can spread [ 2 , 3 , 4 ].…”