Case Report: Does She Have a Fungal Infection or Autoimmune Disease?

Conclusion

Figure 5. Light microscopy of aspirate culture showing Sporothrix schenckii species.

Although cognitive bias likely played a role in our patient’s initial care, the primary team’s systematic approach and early involvement of appropriate specialists helped prevent the significant delays and misdiagnosis often seen in opportunistic illnesses.

As rheumatologists, our role is not only to diagnose and treat rheumatologic disease, but also to consider alternate explanations and to advocate for thorough and appropriate work-up to reasonably exclude infectious etiologies.

Reducing the impact of cognitive bias in the care of our patients will likely necessitate increasing the available rheumatology workforce, and rheumatology educational opportunities during medical training and for our colleagues in practice. 

Sarah Dill, MD, was a third-year rheumatology fellow at the University of Colorado, Aurora, when this article was written. She is now working at the Rocky Mountain Regional VAMC in Aurora, Colo.

Duane Pearson, MD, is an associate professor in the Department of Internal Medicine-Rheumatology at the University of Colorado.

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