Osteomyelitis and pyoarthritis resulting from local paracoccidioidomycosis in an immunocompetent patient: a case report

Abstract

IntroductionParacoccidioidomycosis is a type of mycosis that is endemic to Brazil and is triggered by the fungus Paracoccidioides brasiliensis. Isolated bone involvement in this disease is very rare, especially in children. To the best of our knowledge this report documents the first case of an immunocompetent pediatric patient in which paracoccidioidomycosis of the hip articulation was the sole manifestation of the disease (that is, there were no pulmonary or skin lesions).Case presentationAn 11-year-old Brazilian Caucasian boy from a rural area was examined in the orthopedic ward of our emergency department. Our patient reported a three-month history of pain in the right hip with intermittent claudication and also complained of recurring episodes of intense pain and an inability to walk, which he had been experiencing for the previous five days. He additionally presented with a fever that had persisted for two days. Our patient’s medical history did not include any clinical respiratory manifestations, skin lesions, history of trauma or immunosuppression risk factors.ConclusionsThis is one of the very few reported cases of isolated articular involvement in osteomyelitis in a pediatric immunocompetent patient. Paracoccidioidomycosis should be considered among the differential diagnoses in such cases, especially in cases of patients who reside in rural areas where the condition is considered to be endemic, in order to administer the proper course of treatment in a timely fashion and improve the chances of a favorable prognosis.

Travel- and immigration-related problems in rheumatology

“…Bone involvement is normally accompanied by pulmonary or cutaneous lesions. Bones most commonly affected are scapula, acromion, clavicle, rib, humerus, radius and phalanges [53]. The acromioclavicular joint is particularly commonly involved by extension from the adjoining bone.…”

“…Bony lesions usually produce mild but slowly progressive pain. Extension to an adjacent joint is associated with signs of inflammatory arthritis [53].…”

Pulmonary Paracoccidioidomycosis: A Case Report

“…Paracoccidioidomycosis (PCM) is a type of mycosis caused by the fungus paracoccidioides brasiliensis (PB) that is common to Latin America (1,2), and while it can affect any tissues or organs, it is mostly found in the lung, skin, and mucous membranes (3). The initial lesion is similar to the primary complex of tuberculosis and may be controlled by natural defense mechanisms or may progress to symptomatic disease.…”

Magnetic resonance imaging findings of paracoccidioidomycosis in the musculoskeletal system

“…There are few publications addressing musculoskeletal involvement in PCM, and some of them are contradictory about the most common features [4,5]. The primary involvement of the musculoskeletal system is rare [6][7][8][9][10]. Previous authors suggest bone involvement is part of a multisystem clinical picture [5,[11][12][13].…”

“…The published data about musculoskeletal PCM originate mainly from case reports [6][7][8][9][14][15][16][17][18][19][20]. There are only three series of cases of osteoarticular involvement in PCM [21][22][23].…”