TY - JOUR T1 - Blastomycotic Multifocal Arthritis and Osteomyelitis in the Urban Setting JF - The Journal of Rheumatology JO - J Rheumatol SP - 1627 LP - 1629 DO - 10.3899/jrheum.121115 VL - 40 IS - 9 AU - RACHEL R. JOHNSON AU - SHEETAL S. VORA Y1 - 2013/09/01 UR - http://www.jrheum.org/content/40/9/1627.abstract N2 - To the Editor:Arthritis due to blastomycosis is uncommon and reports of multiple joint involvement are rare. Blastomycosis dermatitidis is endemic in Midwest states around the Great Lakes, the southeast, and the south central United States1,2. Humans acquire this fungus by inhalation of spores from the soil, usually in rural settings3. Infection by blastomycosis is most frequently found in adults aged 20–50 years4,5, with annual incidence reported in up to 100 cases per 100,000 people in specific areas of the United States6. In children, cases are infrequent, accounting for 3%–10% of total reported cases, with pneumonia being the most common manifestation7. Less commonly, blastomycosis has been reported to cause arthritis and/or osteomyelitis in children8,9. Blastomycotic arthritis is usually reported as an acute monoarticular arthritis that may be asymptomatic. Juxtaarticular involvement may lead to osteomyelitis. Involvement of multiple joints is very atypical. In children, only 3 reports have documented arthritis as a presenting manifestation of blastomycosis8,9,10. Of these, only 1 report discusses a child presenting with arthritis of more than 1 joint10.We describe 7 cases of blastomycotic musculoskeletal involvement including osteomyelitis and arthritis with and without accompanying arthritis in children. Two children had more than 1 affected joint, and the majority of these cases were diagnosed in patients without rural exposure, suggesting a possible migration of blastomycosis into urban areas.The medical records of 31 children diagnosed with culture-proven blastomycosis at Children’s Hospital of Wisconsin between 2000 and 2010 were reviewed retrospectively. Items analyzed included patient demographics, clinical findings, radiographic … Address correspondence to Dr. Johnson; E-mail: rajohnson{at}mcw.edu ER -