Abstract
Background The cause of many rheumatic diseases is still unknown. Some Infections might play a role, but the causative evidence is far from definitive. In this arthritic case, an association between a chronic foot fungal infection with Aspergillus sydowii (Aspsy) and arthritis was initially suggested when the treatment of foot hyperkeratosis-like lesions (Xiangya lesions) provoked multiple joints arthritis symptoms. In order to find the association of fungal infection and arthritis, data from scrupulous observations of plantar lesions, arthritic symptoms, and weather features in events of the fungal infection relapses, foot lesion manipulation, or subcutaneous injection of fungal secreted proteins were gathered and analyzed in three years. Case presentation Of the patient, relapses of the fungal infections on Xiangya lesions often occurred after rainy and humid days in winter and spring. Significant relapses of the infection aggravated the symptoms of arthritis within a few days, and the symptoms gradually improved in 2-3 weeks after the remission of fungal infection by topical antifungal treatment. Also, repeated trimming/debriding Xiangya lesion or subcutaneous injection of fungal secreted proteins also induced the arthritis symptoms similar to those of foot fungal infections. Arthritis Dermatitis, bradycardia, hypertension, and elevated blood monocytes were concurrent abnormalities. Topical methotrexate on the fresh trimmed plantar lesions was able to prevent and relieve arthritis. Conclusions Active fungal infections on plantar Xiangya lesions were associated with cold and humid weather in winter-spring or partial lesion debridement. The active fungal infections induced and exacerbated arthritis, dermatitis, and cardiovascular abnormalities. Fungal secreted proteins may mediate the fungal pathogenicity. Effective treatments of the fungal infection improved arthritis and dermatitis. These pathological characteristics have not been described before and could be a new disease, or one of the unknown pathogenic mechanisms for some known rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The results of this research may provide an insight into a novel pathogenic mechanism for some chronic arthritis and may shed light on further clinical studies on the pathogenesis and environmental factors of some rheumatic diseases. Keywords: Arthritis of fungal protein, Aspergillus skin infection, rheumatic diseases pathogenesis, methotrexate, case report
Sinus maxillaris mycetoma of odontogenic origin: case report
