Patients have a history of chronic pain. Sporotrichotic arthritis often occurs without previous overt lung or skin involvement. Transitory arthritis may occur in the primary stage of coccidioidomycosis as part of erythema nodosum. It may also occur later, during dissemination from the original pulmonary focus. Most frequently, the synovium is the primary site of involvement, although coccidioidal arthritis may result from extension of coccidioidal osteomyelitis into the joint space.
Limited information is available about the characteristics of the joint fluid in fungal arthritis.
Polymorphonuclear or mononuclear cells may predominate, the former particularly in candidal arthritis. Another distinctive feature of the pathology of candidal arthritis is that the infected synovium has nonspecific inflammatory infiltrates and no granulomas, which commonly appear in the other fungal arthritides. Although the fungal organisms can frequently be isolated from joint fluid, the diagnosis is made most reliably by means of synovial biopsy and culture. Coccidioidal or blastomycotic arthritis may fluctuate in activity over many years. The treatment of candidal arthritis requires amphotericin B and frequent evacuation of the joint fluid.