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A rare cause of oligoarthritis with septic presentation

Patrick Hoversten1, Joel Beachey1, Michael Pham2

  • 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

BMJ Case Reports
|April 19, 2018
PubMed

Insights

Reactive arthritis, a form of inflammatory arthritis, can present with joint pain and gastrointestinal or genitourinary symptoms. This case highlights a challenging presentation requiring advanced therapies like tumor necrosis factor alpha inhibitors.

Area of Science:

  • Rheumatology
  • Immunology
  • Infectious Disease

Background:

  • Reactive arthritis is an autoimmune condition triggered by infection elsewhere in the body.
  • It commonly affects the joints, eyes, and genitourinary tract.
  • Human leucocyte antigen B27 (HLA-B27) is a genetic marker associated with reactive arthritis.

Observation:

  • A 33-year-old male presented with migratory oligoarthritis, nausea, vomiting, diarrhea, fever, and dysuria.
  • Initial evaluation suggested sepsis, but joint fluid analysis showed inflammatory, not septic, arthritis.
  • The patient had a positive HLA-B27 test.

Findings:

  • The clinical presentation and diagnostic findings were most consistent with reactive arthritis following antecedent gastroenteritis and dysuria.
  • Standard treatments including NSAIDs, glucocorticoids, and sulfasalazine were ineffective.
  • The patient ultimately required a tumor necrosis factor alpha inhibitor for symptom management.

Implications:

  • This case underscores the importance of considering reactive arthritis in patients with inflammatory arthritis and preceding infections.
  • Refractory cases may necessitate advanced immunosuppressive therapies.
  • Early recognition and appropriate management are crucial to prevent long-term joint damage.
Keywords:
infection (gastroenterology)musculoskeletal and joint disordersrheumatology

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