Sporothrix schenckii infection presented as monoarthritis: report of two cases and review of the literature

Abstract

Septic arthritis demands early diagnosis and correct treatment if the function of the joint is to be restored. Sometimes, as in fungal infection, signs and symptoms may be mild and the diagnosis delayed. Nevertheless, the outcome of fungal arthritis is severe and usually causes joint disability. The authors report two patients with chronic monoarthritis due to Sporothrix schenckii infection diagnosed by synovial fluid cultures. Their clinical presentation, laboratory and image findings, and their treatment and follow-up are analyzed and compared to previously reported cases. These cases illustrate the differential diagnosis of monoarthritis in immunocompetent adults and picture clinical features that could lead to early diagnosis and proper treatment.

Sporothrix schenckii and Sporotrichosis

“…In immunocompetent patients, monoarthritis is more frequent than multiple articular involvement. The rarity of musculoskeletal disease in addition to the scarcity of fungal elements in synovial fluid culture and synovial histopathology often delays the diagnosis (11). According to Howell and Toohey, there were only 51 cases of sporothrical arthritis reported in the English literature up to 1998 (102).…”

“…Nocardiosis (caused mainly by Nocardia brasiliensis), chromoblastomycosis, cryptococcosis, blastomycosis, and cat scratch disease also can be differential diagnoses. Sporotrichosis can also mimic cutaneous bacterial infections, sarcoidosis, lupus vulgaris, tuberculosis, and scrofuloderma, among others (11,188,268). These conditions should be differentiated by history, areas of endemicity, and lab tests.…”

A Case of Disseminated Sporotrichosis Treated with Prednisolone, Immunosuppressants, and Tocilizumab under the Diagnosis of Rheumatoid Arthritis

“…Pulmonary, osteoarticular, meningeal, and disseminated sporotrichosis infections are associated with infection of sporothrixschenckii (2)(3)(4)(5)(6). The symptoms of these infections are similar to those of rheumatoid arthritis, as well as those of other connective tissue diseases and angiitis syndromes (7)(8)(9). Only a few studies have reported cases of sporotrichal arthritis patients, in whom disseminated sporotrichosis was induced by immunosuppressive therapy and biological agents (10,11).…”

“…Patients with disseminated-type sporotrichosis, who have smoking and/or alcohol drinking habits, suffer from diabetes mellitus, chronic obstructive pulmonary disease, and/or acquired immunodeficiency syndrome, or have immunosuppressive therapy are considered to fall into a high risk group (2-6, 10, 11). The comparison between sporotrichal arthritis and rheumatoid arthritis is shown in Table 1 (7,8,18). Good similarities are observed in distribution of arthritis, images, and pathology between these diseases.…”

Mycotic infections in rheumatology

“…Диссе-минированные формы возникают преимущественно у им-мунокомпрометированных больных и протекают с пора-жением любых органов и систем, включая опорно-двига-тельный аппарат, легкие и головной мозг. В отличие от других микозов для споротрихоза характерен как моно-, так и олиго-/полиартрит с преимущественным поражени-ем коленных (64%), лучезапястных (50%), локтевых (24%) и голеностопных (20%) суставов [30]. При этом рентгено-логические проявления варьируют от околосуставного ос-теопороза до выраженных изменений по типу «симптома пробойника».…”