Highlights the importance of ruling out Coccidioides infection in pediatric patients presenting with arthritis in endemic areas, especially before initiating biologic immunosuppressive therapy.
May warrant considering coccidioidomycosis in endemic pediatric monoarthritis before immunosuppression; single case leaves open broader diagnostic changes.
Isolated monoarticular synovitis is a rare presentation of coccidioidal disease and has, to our knowledge, never previously been described in the English language pediatric literature. Coccidioidal seropositivity is increasing in incidence in the Southwestern United States. It is critical to rule out Coccidioides infection when evaluating arthritis in the context of residence in or travel to high prevalence areas, even in otherwise healthy patients and especially before administering biologic immunosuppressive therapy.
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Dimitrova et al. (2013) studied this question.
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