SHM Converge Scientific Abstract ePoster Gallery-The Case of a Cryptic Wrist

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This case describes a 71-year-old woman with metastatic thyroid cancer and a kidney transplant, making her immunocompromised and at risk for unusual infections. She was initially admitted for weakness, gastrointestinal symptoms, and dysphagia work-up. During her hospital stay, she developed new right wrist swelling, pain, and decreased range of motion. Imaging with X-ray, ultrasound, and MRI suggested synovitis and tenosynovitis, and the symptoms were initially thought to be consistent with gout. She was started on colchicine and briefly improved, which further reinforced the gout diagnosis.<br /><br />However, wrist arthrocentesis eventually revealed the true cause: septic arthritis due to Cryptococcus neoformans, a rare fungal pathogen. Because of her altered mental status, further evaluation for disseminated disease was performed with lumbar puncture. The CSF showed elevated opening pressure and cryptococcal antigen positivity, confirming central nervous system involvement. Her antifungal treatment was escalated to liposomal amphotericin B plus flucytosine for induction therapy, then transitioned to fluconazole for consolidation and likely long-term suppression. She also underwent wrist debridement and washout.<br /><br />The case highlights several important teaching points: fungal septic arthritis should be considered in immunocompromised patients, symptoms may be nonspecific and mimic gout or other inflammatory conditions, and early synovial fluid analysis is crucial for diagnosis. It also emphasizes the need to assess for disseminated cryptococcal disease when a fungal joint infection is identified, since management changes significantly if the CNS is involved.

Asset Subtitle

Andrea Hart

Meta Tag

Author List Andrea Hart, Manaswitha Thota, Margaret Guy

Category Clinical Vignettes

Concept Septic Arthritis

Concept Differential Diagnosis

Concept Cryptococcal Arthritis

Concept Arthrocentesis

Concept Antifungal Therapy

Distinguished Non-Finalist

Presenter Organization Vcuhs

Presenting Author Andrea Hart

Track Adult

Keywords

cryptococcal arthritis

septic arthritis

Cryptococcus neoformans

immunocompromised

kidney transplant

metastatic thyroid cancer

fungal infection

tenosynovitis

cryptococcal meningitis

liposomal amphotericin B

Septic Arthritis

Differential Diagnosis

Cryptococcal Arthritis

Arthrocentesis

Antifungal Therapy