806706 JFM Journal of Feline Medicine and SurgeryFielder et al
Original Article
Journal of Feline Medicine and Surgery
Feline histoplasmosis presenting 2019, Vol. 21(10) 887–892
© The Author(s) 2018
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DOI: 10.1177/1098612X18806706
https://doi.org/10.1177/1098612X18806706
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This paper was handled and processed
in 25 cats by the American Editorial Office (AAFP)
for publication in JFMS
Susan E Fielder1 , James H Meinkoth1, Theresa E Rizzi1,
Andrew S Hanzlicek2 and Ruth Mackenzie Hallman2
Abstract
Objectives The aim of this study was to describe clinical and diagnostic findings in cats with bone and joint disease
associated with histoplasmosis.
Methods Medical records from between 2011 and 2017 were reviewed. Inclusion criteria required: (1) diagnosis of
histoplasmosis by cytology, histology, urine or serum Histoplasma antigen testing, or culture; and (2) lameness or
joint effusion as a presenting complaint or physical examination finding.
Results Twenty-five cases met the inclusion criteria. Four had incomplete records, but available data were included
when applicable. Lameness was a presenting complaint in 17/21 cats and was the only complaint in 9/21 cats.
Initial diagnosis was made by cytology in 22/25 cats and by culture, urine antigen and necropsy in one case each.
Diagnostic cytology samples included synovial fluid (n = 13), lymph node (n = 5), skin (n = 2), lung (n = 1) and
bone (n = 1). Two additional cases had synovial fluid examined but no organisms present. Inflammation was
present in all synovial fluid samples examined. Biopsy was obtained in two cats and histologic diagnoses included
osteomyelitis with no infectious organisms identified and severe lymphoplasmacytic synovitis suggestive of feline
periosteal proliferative polyarthritis. Histoplasma urine antigen test was positive in 7/12 cats.
Conclusions and relevance Inflammatory arthritis is common in cats with histoplasmosis, with lameness a common
presenting complaint. Organisms are found in synovial fluid cytology in most cases. If not, appropriate additional
diagnostics must be pursued.
Keywords: Histoplasmosis; joint effusion; lameness; polyarthritis; feline chronic progressive polyarthritis; feline
joint disease; synovial fluid cytology
Accepted: 14 September 2018
Introduction
Histoplasma capsulatum is a soil-borne dimorphic fungus cerebrospinal fluid, gingiva, rectal scraping, pleural and
found in temperate and subtropical regions throughout peritoneal fluid, synovial fluid and skin lesions.3
the world including the Central USA.1 Histoplasmosis is
the second most common fungal infection in domestic
cats, with the highest reported incidence in Oklahoma.2
1Veterinary Pathobiology, Oklahoma State University Center
Diagnosis of histoplasmosis is commonly made by
for Veterinary Sciences, Stillwater, OK, USA
identification of the organism on cytology or histopa- 2Veterinary Clinical Sciences, Oklahoma State University Center
thology. H capsulatum is a small round yeast with a thin for Veterinary Sciences, Stillwater, OK, USA
halo and an eccentrically located basophilic nucleus. It is
Corresponding author:
often found within macrophages and neutrophils, but
Susan E Fielder DVM, MS, DACVP, Veterinary Pathobiology,
may also be seen throughout the background.1 H capsula- Oklahoma State University Center for Veterinary Sciences,
tum has been identified in a number of cytology samples, 250 McElroy Hall, Stillwater, OK 74078, USA
including lymph node, spleen, lung, liver, bone marrow, Email: [email protected]
888 Journal of Feline Medicine and Surgery 21(10)
Most cats display disseminated histoplasmosis with four cases from outside clinics for which samples had
non-specific clinical signs, including weakness, weight been submitted to OSU-CPL met the inclusion criteria
loss and anorexia. Respiratory signs are common, and and were also included (total n = 25). Some had incom-
include dyspnea, tachypnea, nasal discharge and a plete medical records and information from these cases
cough.4 Other common findings are fever, lymphade- was included when applicable.
nopathy, splenomegaly, hepatomegaly, signs of ocular
disease and skin lesions.3,4 Musculoskeletal signs are Signalment and presenting complaint
rare but have been reported.2,4 One report of seven cats Mean age at diagnosis was 5 years (range 6 months to 17
with osseous lesions described clinical signs of lameness, years). Thirteen cats were female and 12 were male. The
bone pain, and soft tissue swelling of the limbs and presenting complaint was available in 21 cats. Lameness
joints.5 More recent studies have described lameness and was the most common presenting complaint (17/21;
joint effusion. A 2016 study described 3/15 (20%) cats 81%) and the only complaint in 9/21 (43%) cats. Other
with disseminated disease exhibiting lameness and joint less common presenting signs included lethargy (n = 5),
effusion and a 2017 retrospective study reported 8.9% weight loss (n = 3), fever (n = 1), draining wounds (n =
(9/101) and 15.8% (16/101) of cats with joint effusion 1), blindness (n = 1), generalized pain (n = 1), weakness
and lameness, respectively.6,7 Only a single case of (n = 1) and lymphadenopathy (n = 1).
inflammatory arthritis associated with histoplasmosis
has been reported.8 However, clinical experience in Historical findings and physical examination
endemic areas suggests that bone and joint disease is Lameness was commonly identified on physical exami-
common in cats with histoplasmosis. nation (20/21; 95%). Lameness involved multiple limbs
The objective of this study was to describe the clinical
in 10/20 (50%), a single limb in 9/20 (45%) and was
and diagnostic findings in cats with histoplasmosis with unknown in 1/20 (5%) cats. Lameness was limited to the
bone and joint involvement presented to the Oklahoma forelimbs in 11/19 (58%) and the hindlimbs in 3/19
State University Boren Veterinary Medical Hospital (OSU- (16%). All fore- and hindlimbs were affected in 5/19
BVMH) or Clinical Pathology Laboratory (OSU-CPL). (26%). Joint effusion was identified in 18/24 (75%).
Effusion was found in multiple joints in 9/17 (53%) and
Materials and methods a single joint in 8/17 (47%). The most common joint
Medical records of all cats at OSU-BVMH between affected was the tarsus (n = 10), followed by the carpus
2011 and 2017 were reviewed. Search terms included (n = 9), elbow (n = 7) and stifle (n = 2). In 8/21 (38%)
‘histoplasma’, ‘histoplasmosis’, ‘pneumonia-fungal- cats, clinical signs were confined to the musculoskeletal
histoplasmosis’, ‘polyarthropathy’ and ‘feline chronic system at initial presentation. Fever (>39°C) was seen in
progressive polyarthritis’. Additionally, medical records 18/21 (86%) cats, with 6/21 (29%) cats having marked
obtained from private veterinary clinics for cases diag- pyrexia (>40°C). Other abnormal physical examination
nosed with histoplasmosis from samples submitted to findings included lymphadenopathy (n = 13), weight
the OSU-CPL were also reviewed. The inclusion criteria loss (n = 11), cutaneous lesions (n = 8) and labored
required a diagnosis of histoplasmosis by cytology, his- breathing (n = 2).
tology, urine or serum Histoplasma antigen testing, or
culture, and lameness or joint effusion as a presenting Diagnostics
complaint or physical examination finding, respectively. Initial diagnosis of histoplasmosis was made by cytology
Data extracted from the medical records included sig- in 22/25 cats (88%); other methods of diagnosis included:
nalment (age, sex), clinical signs and physical examina- fungal culture of lymph node (n = 1), urine Histoplasma
tion findings. Results from cytology, histopathology, antigen test (n = 1) and histology from post-mortem
radiographs (orthopedic, thoracic and abdominal), fun- examination (n = 1).
gal culture, Histoplasma antigen testing and other diag- Cytologic samples from which H capsulatum organ-
nostic tests were recorded. Follow-up was obtained from isms were initially identified included synovial fluid
medical records and referring veterinarian contact. (n = 13), lymph node (n = 5), skin (n = 2) lung (n = 1)
Remission was defined as resolution of clinical signs, and bone (n = 1). Three cats diagnosed by synovial fluid
including lameness and joint effusion, resolution or analysis also had H capsulatum organisms found on tis-
stasis of radiographic changes, absence of organism on sue aspirate cytology of lymph node (n = 2), spleen
cytology, and/or negative serum or urine Histoplasma (n = 1) and a cutaneous lesion (n = 1). Organisms were
antigen test. identified in synovial fluid from the tarsus (n = 6), car-
pus (n = 5) and elbow (n = 2). In two cats, organisms
Results were in synovial fluid from multiple joints. Inflammation
Records from 109 cats presented to OSU-BVMH were was found in all synovial fluid samples for which full
reviewed and 21 met the inclusion criteria. Additionally, cytology reports were available (n = 11). Inflammation
Fielder et al 889
was classified as pyogranulomatous (n = 7), suppura- metaphysis of adjacent long bones without adjacent
tive (n = 3) and lymphocytic histiocytic (n = 1). In three articular surface lysis. Other non-articular or metaphyseal
cats inflammation was present, but organisms were not osseous lesions, all described as well-defined punctate
identified on initial cytology of synovial fluid. One cat lucencies, were identified in 4/25 (16%) cats. Thoracic
was tentatively diagnosed with feline periosteal prolif- radiographs were performed in 13/25 (52%) cats and
erative polyarthritis based on clinical signs, radiographic one cat had an abdominal radiograph. Pulmonary abnor-
changes and the presence of suppurative inflammation malities were identified in 8/13 (62%) and were described
with no organism on synovial fluid cytology. H capsula- as either diffuse interstitial (n = 4), nodular (n = 2) or
tum was identified on repeat synovial fluid cytology 2 both (n = 2) pulmonary patterns. The remaining 5/13
months after initiation of immunosuppressant therapy. (38%) were described as unremarkable. Concurrent
In a second cat, diagnosis was made by urine hepatomegaly was identified in the cranial abdomen of
Histoplasma antigen test. In a third cat, urine and serum 3/13 (23%).
Histoplasma antigen tests were negative; however, H cap- Hematologic (n = 20) and biochemical (n = 20) data
sulatum was cultured from an enlarged, inflamed lymph were evaluated. Anemia was identified in 10/20 (50%)
node adjacent to an affected joint. and most (9/10) were classified as non-regenerative,
Urine Histoplasma antigen test was positive in 7/10 based on blood smear evaluation. A mature neutrophilia
(70%) cats. Both urine and serum Histoplasma antigen was identified in 13/20 (65%) and 5/20 (25%) had a band
tests were performed in two cats. Urine Histoplasma anti- neutrophilia (Table 1). Platelets were difficult to assess
gen test was negative in one cat and serum Histoplasma due to platelet clumping in 13/20 (65%). While an accu-
antigen test was negative in both cats. rate platelet count could not be obtained for these sam-
Biopsy of the affected joint was obtained in two cats. ples, all were determined to be adequate based on blood
One cat was diagnosed with osteomyelitis with no smear review and thrombocytopenia was not identified
infectious organisms identified, including staining with in any sample. Biochemistry abnormalities included
Gomori’s methenamine silver (GMS) to specifically hyperbilirubinemia in 6/17 (35%), hyperglobulinemia in
exclude fungal infection. Despite 6 months of antibiotic 5/19 (26%), hypoalbuminemia in 4/19 (21%) and hyper-
therapy, lameness progressed to multiple joints with calcemia in 2/19 (11%) (Table 2).
joint effusion noted in the joint previously biopsied.
H capsulatum was identified on cytology of synovial Outcome
fluid from this joint. Treatment with itraconazole Initial follow-up data were available for 21 cats and
resulted in resolution of clinical signs by 5 weeks. A sec- 18/21 (86%) survived to hospital discharge. Follow-up
ond cat was diagnosed with severe lymphoplasmacytic until resolution of clinical signs was available for eight
synovitis and bone proliferation of the hock. Staining cats and mean time to resolution of lameness in those
with GMS did not reveal H capsulatum organisms and a cats was 16 weeks (range 4–36 weeks). Resolution of
presumptive diagnosis of feline periosteal progressive joint effusion was noted concurrently with resolution of
arthritis was made. One year of immunosuppressive lameness in all but two cats in which joint effusion per-
therapy resulted in only mild transient improvement of sisted for an additional 4 and 16 weeks. Synovial fluid
clinical signs. Subsequent cytologic evaluation of an cytology was repeated in only one cat. In this cat, five
enlarged popliteal lymph node adjacent to the previ- samples were examined over a period of 9 months after
ously biopsied joint revealed pyogranulomatous initial diagnosis and suppurative inflammation was
inflammation and H capsulatum organisms. Treatment identified in all, although H capsulatum was not present
with itraconazole resulted in resolution of lameness. in any sample after the start of antifungal therapy.
Initial orthopedic radiographs were available for Seven cats had at least one set of follow-up ortho-
18/25 (72%) cats, for a total of 41 separate orthopedic pedic radiographs, with a total of 15 separate joints
studies, including the tarsus (n = 17), carpus (n = 16), having at least one follow-up. One cat that initially pre-
elbow (n = 5), antebrachium (n = 2) and shoulder (n = sented with carpal or tarsal soft tissue swelling only had
1). Eleven of those cats had two or more joints or long articular lysis on a subsequent examination. Animals
bones imaged at least once and 9/11 (82%) had multiple with metaphyseal lysis tended to have slowly improving
joints or long bones affected. Of these studies, 5/41 (12%) remodeling of these regions, while animals with joint
were described as unremarkable (two tarsi and three disease were generally described as having unchanged
elbow studies). Intracapsular and/or extracapsular soft amounts of cuboidal bone lysis, improved long bone
tissue swelling was identified in 26/33 (79%) combined diaphyseal/metaphyseal lysis with remodeling, increased
carpal and tarsal studies. Osseous lesions were identi- amounts of periosteal or periarticular new bone, sclero-
fied in 29/33 (88%) carpal and tarsal radiographs; 19/29 sis and joint space collapse. One cat with follow-up
(66%) had lysis of cuboidal bones, six of which had thoracic radiographs showed improvement of pulmo-
metaphyseal lysis, and 10/29 (34%) had lysis of the nary nodules.
890 Journal of Feline Medicine and Surgery 21(10)
Table 1 Hematologic data in cats with bone- and joint-associated histoplasmosis
Variable n RI Mean SD Median Range Number Number
lower than higher than
RI (%) RI (%)
White blood cells (k/µl) 20 3.5–16 15.3 4.7 15.3 5.1–24.1 0 (0) 9 (45)
Segmented neutrophils (k/µl) 20 2.5–8.5 10.4 4.2 10.1 3.8–19.1 0 (0) 13 (65)
Band neutrophils (k/µl) 20 0–0.3 0.3 0.8 0 0–3.1 0 (0) 5 (25)
Lymphocytes (k/µl) 20 1.2–8.0 3.7 2.7 3 4.5–11.3 3 (15) 1 (5)
Monocytes (k/µl) 20 0–0.6 0.6 0.5 0.4 0.1–2.2 4 (20) 0 (0)
Eosinophils (k/µl) 20 0–1.0 0.4 0.4 0.3 0–1.1 0 (0) 2 (10)
HCT (%) 20 29–48 29 6 28 21–40 10 (50) 0 (0)
MCV (fL) 20 37–61 45 6 44 36–61 1 (5) 0 (0)
MCHC (g/dl) 20 30–38 32 2 32 29–35 2 (10) 0 (0)
RI = reference interval; HCT = hematocrit; MCV = mean cell volume; MCHC = mean cell hemoglobin concentration
Table 2 Biochemical data in cats with bone- and joint-associated histoplasmosis
Variable n RI Mean SD Median Range Number lower Number higher
than RI (%) than RI (%)
TP (g/dl) 19 5.2–8.8 7.7 0.8 7.6 6.6–9.9 0 (0) 1 (5)
Alb (g/dl) 19 2.5–3.9 2.7 0.3 2.7 2.2–3.3 4 (21) 0 (0)
Glob (g/dl) 18 2.3–5.3 4.9 0.9 4.8 3.5–7.1 0 (0) 5 (28)
AST (U/l) 12 10–100 41 20 42 12–79 0 (0) 0 (0)
ALT (U/l) 18 10–100 57 54 45 10–230 0 (0) 2 (11)
ALP (U/l) 18 6–102 24 12 22 10–53 0 (0) 0 (0)
GGT (U/l) 15 1–10 4.2 4.4 2 1–14 0 (0) 2 (13)
T bili (mg/dl) 17 0.1–0.4 0.5 0.7 0.2 0.1–2.2 0 (0) 6 (35)
BUN (mg/dl) 20 14–36 25 23 20 10–121 1 (5) 1 (5)
Creat (mg/dl) 19 0.6–2.4 1.1 0.8 0.8 0.5–4.4 1 (5) 1 (5)
P (mg/dl) 16 2.4–8.2 5.7 1.8 5.2 3.8–10.9 0 (0) 1 (6)
Gluc (mg/dl) 19 64–170 121 32 119 78–197 0 (0) 2 (11)
Ca (mg/dl) 16 8.2–10.8 9.5 0.8 9.4 8–11 1 (6) 2 (13)
Mg (mg/dl) 11 1.5–2.5 1.7 0.3 1.7 1.3–2.5 2 (18) 0 (0)
Na (mg/dl) 17 145–158 151 2.3 152 147–155 0 (0) 0 (0)
K (mg/dl) 17 3.4–5.6 4.1 0.6 4.1 3.5–6.0 0 (0) 1 (6)
Cl (mg/dl) 17 104–128 119 2 119 114–124 0 (0) 0 (0)
Chol (mg/dl) 16 75–220 129 45 129 62–225 2 (13) 1 (6)
Trig (mg/dl) 11 25–160 39 17 40 18–76 3 (27) 0 (0)
Amy (U/l) 15 100–1200 807 332 823 132–1401 0 (0) 1 (7)
CPK (U/l) 16 56–529 458 974 102 39–4093 1 (6) 2 (13)
RI = reference interval; TP = total protein; Alb = albumin; Glob = globulin; AST = aspartate aminotransferase; ALT = alanine aminotransferase;
ALP = alkaline phosphatase; GGT = gamma-glutamyl transferase; T bili = total bilirubin; BUN = blood urea nitrogen; Creat = creatinine;
P = phosphorus; Gluc = glucose; Ca = calcium; Mg = magnesium; Na = sodium; K = potassium; Cl = chloride; Chol = cholesterol;
Trig = triglycerides; Amy = amylase; CPK = creatine phosphokinase
Discussion in all cases in which sampling of synovial fluid was pur-
Inflammatory arthritis is a common, but potentially sued. Similar clinical signs have been described in cats with
under-reported, manifestation of histoplasmosis in cats in disseminated histoplasmosis, but synovial fluid was not
endemic areas. A recent retrospective study of cats with evaluated in those cases.5,9–11 Only a single case report
histoplasmosis reported 15.8% of cats with lameness and (which is included in the present retrospective study) of
8.9% with joint effusion.7 We report here 25 cases of feline inflammatory arthritis was identified in the literature.8
histoplasmosis in which lameness or joint effusion was Lameness was the most common presenting com-
either the presenting complaint or a prominent physical plaint in the present study and was the only presenting
examination finding. Inflammatory arthritis was identified complaint in nearly half of the cats. These findings are
Fielder et al 891
similar to articular histoplasmosis cases in humans in organisms were not identified, it should be considered
which the only presenting signs were painful and/or that the inflammation in these cats may represent a sec-
swollen joints.12–16 Lameness has been reported as a less ondary immune-mediated polyarthritis rather than an
common clinical sign in other studies of histoplasmosis infectious arthritis. However, H capsulatum was eventu-
in cats, but it was not further characterized in those stud- ally confirmed in these cases and is likely the cause of the
ies and there was no mention of synovial fluid find- inflammation seen in these cats by either mechanism.
ings.2,4,6,7 Smaller joints (ie, tarsus, carpus) were most Anemia was a common finding in these cats and was
commonly affected in our study and this is consistent typically non-regenerative. This is consistent with previ-
with previously reported findings in cats.5,9,10 ous reports of cats with disseminated histoplasmosis and
Monoarthritis and polyarthritis were identified in is thought to be multifactorial, although anemia of
equal numbers based on physical examination in the cats chronic inflammation is the most likely cause. In contrast
in this study. This is in contrast to human studies where to previous reports of neutropenia in cats with dissemi-
monoarthritis is considered rare.12 It is likely that many nated histoplasmosis, more than half of the cats in this
of our cases that were identified as monoarticular based study had a neutrophilia; however, the left shift seen with
on physical examination actually had polyarticular dis- many of these cats is consistent with previous findings.
ease that was not clinically evident. This is supported by As reported in other studies, lymphopenia was identified
the fact that approximately 82% of the radiographic in some of the cats in this study. Thrombocytopenia is
studies identified soft tissue and bony changes in more reported as a common finding in cats with disseminated
than one joint, when these were performed. This sug- histoplasmosis, but thrombocytopenia was not identified
gests that radiographic studies of multiple joints may be in this study.
informative even in patients for which clinical presenta- Hyperbilirubinemia was the most common biochemi-
tion appears monoarticular. cal abnormality found in this group of cats and has been
Joint effusion was identified in most cats in this study previously described in cats with disseminated histo-
and inflammatory arthritis was diagnosed in all synovial plasmosis. This may be due to liver disease secondary to
fluid samples that were evaluated cytologically. The hepatic involvement in disseminated disease or hepatic
inflammatory response was most commonly classified lipidosis associated with anorexia. Hypoalbuminemia
as pyogranulomatous. Inflammatory arthropathy is more and hyperglobulinemia are likely associated with inflam-
common in dogs than in cats. In dogs, most inflamma- mation and have been previously reported in cats with
tory arthropathies result from either immune-mediated disseminated histoplasmosis.
or bacterial joint disease and typically produce a suppu- The urine Histoplasma antigen test from Mira Vista
rative (purulent) inflammation.17 Thus, a pyogranuloma- Diagnostics has been shown to be a sensitive test (89.7%)
tous inflammatory response should arouse suspicion, for the diagnosis of disseminated histoplasmosis in
especially in cats from Histoplasma species-endemic areas cats.18,19 This test was negative in 3/10 (30%) cats
or travel history to endemic areas. reported in the current study. Disease was isolated to the
Cytology of synovial fluid was often diagnostic not just bone and joints in these three cats and diagnosis was
of inflammation, but Histoplasma organisms were identified delayed in all with a presumptive diagnosis of feline
in 13/15 patients for which synovial fluid was evaluated. periosteal proliferative arthritis in two cats. This sug-
Organisms were often present in very low numbers, and gests that the sensitivity of this test in cats with disease
were found only after prolonged examination. In cases confined to the joint might be lower than that for cats
where synovial fluid was not diagnostic for histoplasmosis, with disease in other organ systems. Localized disease
multiple joints were sampled and significant inflammation, likely leads to lower antigen loads and ultimately
either suppurative or pyogranulomatous, was present. decreased performance of urine antigen testing. A posi-
Diagnosis was attained by urine Histoplasma antigen test in tive urine Histoplasma antigen test suggests histoplasmo-
one cat. In the second cat, multiple urine and serum sis, but a negative test does not rule out histoplasmosis
Histoplasma antigen tests were negative and a diagnosis involving bone and joint.
was reached when H capsulatum was cultured from an adja- Inherent in most retrospective studies, there were sev-
cent enlarged, inflamed lymph node aspirate. eral limitations including a lack of standardization of
These findings demonstrate that synovial fluid cytol- history and clinical findings, as well as cytologic, histo-
ogy is often diagnostic if there is sufficient clinical index of pathologic and radiographic descriptions. Also, many of
suspicion to warrant a prolonged search for the organ- the medical records were incomplete and four of the
isms. However, even with this some cases require addi- cases had minimal data beyond history and cytologic
tional testing such as Histoplasma antigen testing. Fungal findings. The authors felt that these data were still
culture of adjacent enlarged lymph nodes or joint fluid informative and included findings where applicable.
may also be helpful, but should be interpreted in conjunc- Follow-up data were not available for most of the cases
tion with other evidence of disease. In the few cases where and, when available, it included little clinical information
892 Journal of Feline Medicine and Surgery 21(10)
or repeat diagnostics. This precluded further conclu- disease relapse in cats with histoplasmosis. J Vet Intern
sions about remission rate and clinical outcome. Med 2016; 30: 1065–1073.
7 Ludwig HC, Hanzlicek AS, KuKanich KS, et al. Candi-
date prognostic indicators in cats with histoplasmosis
Conclusions treated with antifungal therapy. J Feline Med Surg 2018;
To our knowledge, synovial fluid findings associated 20: 985–996.
with histoplasmosis involving the bone and joint have 8 Rochat M and Crystal M. Companion-animal practice-
not been previously described in cats. In many cases challenging cases in internal medicine: what’s your diag-
musculoskeletal signs may be the primary or only clini- nosis? Vet Med 1999; 94: 520–529.
cal finding. Cytologic evaluation of synovial fluid was 9 Mahaffey E, Gabbert N, Johnson D, et al. Disseminated his-
often diagnostic, but some cases required additional test- toplasmosis in three cats. J Am Anim Hosp Assoc 1977; 13:
ing, such as testing urine or serum for Histoplasma anti- 46–51.
gen or culture of affected tissues. In endemic areas, 10 Goad MEP and Roenick WJ. Osseus histoplasmosis in a
histoplasmosis should be suspected in cats presenting cat. Feline Pract 1983; 13: 32–36.
11 Aronson E, Bendickson JC, Miles KG, et al. Disseminated
with musculoskeletal signs.
histoplasmosis with osseous lesions in a cat with feline
lymphosarcoma. Vet Radiol Ultrasound 1986; 27: 50–53.
Conflict of interest The authors declared no potential
12 Darouiche R, Cadle R, Zenon G, et al. Articular histoplas-
conflicts of interest with respect to the research, authorship,
mosis. J Rheumatol 1992; 19: 1991–1993.
and/or publication of this article.
13 Makol A, Wieland CN and Ytterberg SR. Articular
involvement in disseminated histoplasmosis in a kidney
Funding The authors received no financial support for the transplant patient taking azathioprine. J Rheumatol 2011;
research, authorship, and/or publication of this article. 38: 2692–2693.
14 Sen D, Birns J and Rahman A. Articular presentation
ORCID iD Susan E Fielder https://orcid.org/0000-0002- of disseminated histoplasmosis. Clin Rheumatol 2007;
7554-2491 26: 823–824.
15 Van der Schee A, Dinkla B and Festen J. Gonarthritis as
References only manifestation of chronic disseminated histoplasmo-
1 Bromel C and Greene C. Histoplasmosis. In: Greene CE sis. Clin Rheumatol 1990; 9: 92–94.
(ed). Clinical microbiology and infectious diseases of the 16 Weinberg JM, Ali R, Badve S, et al. Musculoskeletal histo-
dog and cat. 4th ed. Philadelphia, PA: Saunders, 2012, pp plasmosis: a case report and review of the literature. J Bone
614–621. Joint Surg 2001; 83: 1718–1722.
2 Davies C and Troy G. Deep mycotic infections in cats. J Am 17 Cowell R and Arndt T. Selected infectious agent. In: Valen-
Anim Hosp Assoc 1996; 32: 380–391. ciano A and Cowell R (eds). Cowell and Tyler’s diagnostic
3 Brömel C and Sykes JE. Histoplasmosis in dogs and cats. cytology and hematology of the dog and cat. St Louis, MO:
Clin Tech Small Anim Pract 2005; 20: 227–232. Elsevier Mosby, 2014, pp 51–52.
4 Aulakh HK, Aulakh KS and Troy GC. Feline histoplas- 18 Cook AK, Cunningham LY, Cowell AK, et al. Clinical
mosis: a retrospective study of 22 cases (1986–2009). J Am evaluation of urine Histoplasma capsulatum antigen
Anim Hosp Assoc 2012; 48: 182–187. measurement in cats with suspected disseminated histo-
5 Wolf A. Histoplasma capsulatum osteomyelitis in the cat. plasmosis. J Feline Med Surg 2012; 14: 512–515.
J Vet Intern Med 1987; 1: 158–162. 19 Cunningham L, Cook A, Hanzlicek A, et al. Sensitivity and
6 Hanzlicek AS, Meinkoth JH, Renschler JS, et al. Antigen specificity of Histoplasma antigen detection by enzyme
concentrations as an indicator of clinical remission and immunoassay. J Am Anim Hosp Assoc 2015; 51: 306–310.
