title: Radiologic findings of osteoarticular infection in paracoccidioidomycosis.
abstract: OBJECTIVE
  To report the radiological abnormalities of osteoarticular involvement in paracoccidioidomycosis (PCM).
  
  
  METHODS
  After institutional board approval, the medical records and conventional radiology findings of 19 patients with osseous PCM were retrospectively reviewed. Number, distribution, and lesion characteristics were evaluated in consensus by two experienced musculoskeletal radiologists.
  
  
  RESULTS
  The mean age of patients was 16.1 years (range 4-49 years), 11 male and eight female. MSK involvement was the only or the primary presentation of the disease in eight of 19 patients (42.1%). In total, 51 focal bone lesions were detected, being 41 in long bones. In long bones lesions, 19 of 41 (46.4%) were metaphyseal, 12 of 41 (29.3%) meta-epiphyseal, and 12 of 41 (29.3%) diaphyseal. The most common presentation was a geographic osteolytic bone lesion (62.7%), without marginal sclerosis (82.4%) and without periosteal reaction (90.2%). Articular involvement was present in six of 19 patients (31.6%), being two cases of primary arthritis.
  
  
  CONCLUSIONS
  All encountered bone lesions were osteolytic. Metaphyseal or meta-epiphyseal osteomyelitis of a long bone was the most prevalent osteoarticular manifestation of paracoccidioidomycosis. PCM osteoarticular involvement could be solitary or multifocal, occurs almost exclusively in the acute/subacute clinical form, and it is more common in children and in juvenile patients. Axial skeleton involvement, arthritis, or a disseminated osseous pattern of infection may occasionally occur in this fungal disease.
authors.affiliation: Division of Radiology of the Internal Medicine Department, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Av. Bandeirantes, 3900 CEP, 14049-090 Ribeirao Preto, Brazil.
authors.forename: Lucas Moretti
authors.initials: LM
authors.lastname: Monsignore
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
authors.forename: Marcelo Novelino
authors.initials: MN
authors.lastname: Simão
authors.forename: Sara Reis
authors.initials: SR
authors.lastname: Teixeira
authors.forename: Jorge
authors.initials: J
authors.lastname: Elias
authors.forename: Marcello Henrique
authors.initials: MH
authors.lastname: Nogueira-Barbosa
mesh_terms: D000293:Adolescent; D001168:Arthritis / Q000209:etiology*; D001175:Arthrography; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010000:Osteitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D010229:Paracoccidioidomycosis / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity