Abstract
Mycoleptodiscus indicus is a recognized plant pathogen which has very rarely been reported as a cause of human infection. It is a tropical or subtropical fungus which is difficult to culture and identify from clinical specimens. This is the first report of septic arthritis with this fungus in a healthy Canadian male. The fungal infection was contracted on a vacation in Costa Rica, probably through direct inoculation through injured skin. The fungus was isolated from synovial fluid and identification was confirmed by DNA sequencing. There has only been one previous case of septic arthritis of the knee and one skin infection reported with this fungus; both cases involved immunocompromised hosts. Both septic arthritis patients required joint surgery and lavage to eradicate the fungus, however, only the immunocompromised patient required antifungal medications. In the future, it is very likely that the number of patients identified with M. indicus infection will rise due to increasing awareness of this pathogen as well as increasing exposure. Many immunocompromised patients on anti-retroviral or biologic therapy are healthy enough to travel, thereby exposing themselves to exotic and infected plants which increase the risk of unusual fungal infections.
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Acknowledgments
Ms. C. Sand, Mycology Reference Centre, University of Alberta Hospitals, Edmonton for antifungal susceptibility, Dr. C.F.C. Gibas, UAMH, for assistance in DNA sequencing, Dr. J. Dunwoody, Lions Gate Hospital, North Vancouver (LGH) for arthroscopic surgery, Dr. E. Bryce, Vancouver General Hospital for forwarding the unidentified fungus to L.S. at UAMH, Dr. S. Yoshida, LGH for help with MRI images, Dr. P. Cohen, LGH for help with bone and gallium scans, and Dr. J. Hayward, North Vancouver, for referring the patient to C.D. for a Rheumatology opinion. L.S. has received financial support from the Natural Sciences and Engineering Research Council of Canada. Both authors have no conflicts of interest to report.
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Dewar, C.L., Sigler, L. Fungal arthritis of the knee caused by Mycoleptodiscus indicus . Clin Rheumatol 29, 1061–1065 (2010). https://doi.org/10.1007/s10067-010-1448-9
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DOI: https://doi.org/10.1007/s10067-010-1448-9