PMC7705290_01
Purulent lesion on the dorsal aspect of the right wrist.
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He also developed a scaly plaque-like lesion with skin breakdown in the same area (Figure 1).
Swelling and skin changes (red arrow) involving the right knee.
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Furthermore, he had developed similar scaly plaque-like lesions over the anterolateral aspect of his left knee; however, without any skin breakdown or discharge (Figure 2).
X-ray of left knee showing osteopenia with loss of cortical margination
involving the medial and lateral epicondyles, medial and lateral tibial
plateau, and patella (yellow arrows). Large joint effusion (red arrow), and
soft tissue swelling (blue arrow).
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
X-ray of left ankle showing lucency involving the medial and lateral
malleoli.
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
X-ray of right wrist showing pronounced osteopenia with areas of cortical
irregularity involving the first through fourth metatarsal bases and several
carpal bones with surrounding soft tissue swelling.
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
X-ray of the left elbow showing lucency of the olecranon process (yellow
arrow) with moderate joint effusion and a large amount of left elbow soft
tissue swelling (blue arrow).
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
X-ray of the left knee showing interval progression of osteopenia and erosive
changes involving the medial and lateral femoral condyles as well as tibial
plateau and patella (yellow arrows). It also shows an increased size of the
joint effusion (red arrows) as well as surrounding soft tissue swelling
(blue arrow).
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
X-ray of right wrist showing interval progression of osteopenia and erosive
change involving the bases of the second through fifth metacarpals, carpal
bones, and radial styloid (yellow arrows), with surrounding soft tissue
swelling. Skin irregularity involving the dorsal wrist soft tissues at the
site of the purulent skin lesion is also noted (green arrow).
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Further investigation including X-ray imaging of the affected joints showed interval progression of the osteopenia along with erosive changes (Figures 3-8).
Gram stain of synovial fluid from the left elbow showing spherules (blue
arrows) resembling Coccidioides sp under light
microscopy.
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Gram stain and KOH wet mount of both synovial fluids plus the draining purulent fluid from the right wrist showed evidence for spherules resembling Coccidioides sp (Figure 9).
Chest X-ray showing subsegmental right lower lung zone patchy airspace
disease.
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A chest X-ray was performed and showed subsegmental right lower lung zone patchy airspace disease (Figure 10).
Bone scan showing abnormal uptake seen in the right wrist, left elbow, and
left knee (red arrows).
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A whole-body bone scan was performed to investigate for osseous involvement and showed abnormal uptake in the right wrist, left elbow, and left knee consistent with disseminated osseous coccidioidomycosis (Figure 11).