Magnetic resonance imaging in coccidioidal arthritis

Lund, Pamela J.; Chan, Krammle; Unger, Evan C.; Galgiani, T. N.; Pitt, Michael J.

doi:10.1007/s002560050154

Cited by 29 publications

(22 citation statements)

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“…However, synovial culture is recommended to distinguish coccidioidal from tuberculous synovitis (1). MR imaging reveals findings, although typically with less synovial proliferation, similar to those in the case presented here (5). The hypertrophied synovium enhances after intravenous administration of gadolinium-based contrast material (3,5).…”

Section: Volume 224 ⅐ Numbersupporting

confidence: 67%

“…MR imaging reveals findings, although typically with less synovial proliferation, similar to those in the case presented here (5). The hypertrophied synovium enhances after intravenous administration of gadolinium-based contrast material (3,5). Gadolinium enhancement can also assist in distinguishing enhancing synovium from nonenhancing joint fluid, regardless of the cause of the synovitis (3,12,13).…”

Section: Volume 224 ⅐ Numbersupporting

confidence: 64%

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Case 50: Primary Coccidioidal Synovitis of the Knee

May

Disler²

2002

Radiology

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A 42-year-old African-American man had slowly progressive swelling of the left knee. Prior assessments were performed at another hospital during the preceding 5 months. On the basis of results of these assessments, a diagnosis of inflammatory joint effusion was established. This condition did not respond to therapy with several courses of antibiotics. Physical examination revealed a swollen, mildly warm left knee with normalappearing overlying skin. Physical examination disclosed no other abnormalities. Posteroanterior and lateral chest radiographs revealed a round noncalcified 6-mm nodule in the left upper lobe of the left lung but showed no other abnormalities. The patient lived in Virginia and reported previous travel to the southwestern and western United States. Gram stain and culture of aspirated joint fluid did not reveal an organism. Results of the purified protein derivative skin test for tuberculosis were negative. There was no evidence of immune system dysfunction or of renal failure.

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Section: Volume 224 ⅐ Numbersupporting

confidence: 67%

Section: Volume 224 ⅐ Numbersupporting

confidence: 64%

Case 50: Primary Coccidioidal Synovitis of the Knee

May

Disler²

2002

Radiology

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“…In one study, 7 there were 13 musculoskeletal cases of a total of 330 cases reviewed (approximately 4%). Other collections of orthopedic cases, 6,11,12 including a literature review, 7 do not indicate a denominator. In one recent review of 223 primary infections confirmed by elevated complement fixation titers, 50 were extrapulmonary and 28 of those (13% of the total and 56% of the systemic cases) were musculoskeletal.…”

Section: Discussionmentioning

confidence: 98%

Musculoskeletal Coccidioidomycosis

Taxy

Kodros

2005

Am J Clin Pathol

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Coccidioidomycosis is a primary pulmonary infection, endemic to the southwestern United States, caused by inhalation of spores in an immunocompetent host. When systemic spread occurs, the dissemination of infection to musculoskeletal sites might account for 20% to 50% of cases. The musculoskeletal manifestations are well recognized by physicians in endemic areas. We report 2 cases encountered in metropolitan Chicago in which morphologically typical, large, yeast-like, encapsulated, endosporulating organisms were identified in tissue samples and Coccidioides immitis was cultured. One patient had a degenerative-type radiographic picture thought to be related to a sports injury. A second patient with skin lesions and a paraspinal mass required emergency decompressive spinal surgery. A history consistent with exposure to Coccidioides organisms was apparent only for the first patient. Although the diagnosis can be established morphologically by identifying the large endospores in tissue samples, the submission of samples for culture and subsequent microbiologic confirmation requires the diagnosis to be considered clinically. This report emphasizes the rarity of the organism in nonendemic areas and the redundant value of using both morphologic and microbiologic modalities.

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“…Infections of virtually all joints have been described. Infections of the knee, elbow, wrist, and ankle are commonly seen, with the knee most frequently involved [51][52][53]. Dissemination similarly has been described in almost every bone.…”

Section: Disseminated Diseasementioning

confidence: 91%