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Rickettsioses presenting as major joint arthritis and erythema nodosum: description of four patients

R Premaratna1, T G A N Chandrasena, R P V J Rajapakse

  • 1Department of Medicine, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, Sri Lanka. ranjan_premaratna@lycos.com

Clinical Rheumatology
|March 26, 2009
PubMed

Insights

Rickettsial infections can cause severe joint pain and erythema nodosum, even without high fever. Prompt treatment with doxycycline effectively resolved symptoms in affected patients.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Dermatology

Background:

  • Erythema nodosum and aseptic arthritis are known manifestations of rickettsial infections.
  • Typically, these presentations are associated with febrile illness, not severe joint involvement.

Observation:

  • This report details four patients with severe arthritis, including incapacitating major joint arthritis and spondyloarthropathy.
  • These cases were linked to serologically confirmed Orientia tsutsugamushi and Rickettsia conorii infections.
  • All patients exhibited erythema nodosum and low-grade fever, differing from the usual febrile presentation.

Findings:

  • The study identified a subset of rickettsial infections presenting with severe, debilitating arthritis and erythema nodosum.
  • The causative agents were identified as Orientia tsutsugamushi and Rickettsia conorii.
  • Patients demonstrated a rapid clinical improvement following doxycycline treatment.

Implications:

  • This highlights the potential for rickettsial infections to cause severe rheumatological manifestations beyond typical presentations.
  • Early recognition and treatment with doxycycline are crucial for managing these severe joint complications.
  • Clinicians should consider rickettsial etiologies in patients presenting with severe arthritis and erythema nodosum, even with minimal fever.

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