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Updated: Oct 1, 2025
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
A Case Report and Review of the Literature: Reactive Arthritis Caused by Clostridioides difficile ribotype 027
Ortrud Zimmermann1, Heinrich Köchel1, Wolfgang Bohne1
1Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany.
Abstract:
With an annual incidence of 250-300 per 100,000 inhabitants, reactive arthritis is not uncommon. However, the fact that Clostridioides difficile infection (CDI) can also lead to this complication is largely unknown. We report on a 69-years-old man who developed reactive arthritis of his right knee joint one week after antibiotic-associated diarrhea with evidence of C. difficile of the hypervirulent ribotype 027. His female partner also became infected with C. difficile ribotype 027, but did not develop reactive arthritis. The further investigation showed that the patient - in contrast to his partner - was HLA-B27 positive and had strong antibody levels against C. difficile. The case history together with the review of 45 other cases described so far shows that C. difficile can also lead to reactive arthritis. C. difficile-associated reactive arthritis (CDARA) is characterized by the fact that patients suffer from diarrhea or colitis after taking antibiotics, toxigenic C. difficile or only the toxins are detectable in the stool and there are no other explanations for the arthritis and diarrhea.
Insights
Clostridioides difficile infection (CDI) can cause reactive arthritis, a complication previously unrecognized. This finding highlights a new potential cause for reactive arthritis, particularly in patients with a history of antibiotic-associated diarrhea.
Area of Science:
- Infectious Diseases
- Rheumatology
- Microbiology
Background:
- Reactive arthritis is a common condition with a significant incidence.
- Clostridioides difficile infection (CDI) is a known cause of antibiotic-associated diarrhea and colitis.
- The association between CDI and reactive arthritis is not widely recognized.
Purpose of the Study:
- To report a case of reactive arthritis following Clostridioides difficile infection.
- To review existing literature on CDI-associated reactive arthritis (CDARA).
- To characterize the clinical features and potential risk factors for CDARA.
Main Methods:
- Case report of a 69-year-old male patient with reactive arthritis post-CDI.
- Review of 45 previously described cases of CDI-associated reactive arthritis.
- Analysis of patient's HLA-B27 status and antibody levels against C. difficile.
Main Results:
- The patient developed reactive arthritis of the knee one week after antibiotic-associated diarrhea caused by hypervirulent C. difficile ribotype 027.
- The patient was HLA-B27 positive and had high antibody levels against C. difficile, unlike his infected partner.
- Literature review and case analysis confirm CDI as a cause of reactive arthritis.
Conclusions:
- Clostridioides difficile infection is an under-recognized cause of reactive arthritis.
- CDARA is characterized by preceding antibiotic use, diarrhea/colitis, detectable C. difficile or toxins, and absence of other arthritis causes.
- HLA-B27 positivity and strong antibody response to C. difficile may be risk factors for developing CDARA.
