Reactive arthritis with eosinophilic synovial infiltration

Area of Science:

• Rheumatology
• Infectious Diseases
• Genetics

Background:

• Subacute seronegative arthritis presents a diagnostic challenge, particularly when initial treatments are ineffective.
• Eosinophilic infiltration of synovial tissue is an uncommon finding in arthritis.

Observation:

• A 17-year-old female presented with arthritis affecting her ankles and midfoot.
• Synovial biopsy revealed significant eosinophilic infiltration.
• Ankylostoma duodenale (a parasitic worm) was identified, and the patient was positive for HLA B27 antigen.

Findings:

• The patient exhibited peripheral eosinophilia and subacute arthritis.
• Despite antiparasitic treatment, her symptoms showed minimal improvement.
• The presence of HLA B27 suggests a possible reactive arthropathy, though its relation to the parasitic infection is unclear.

Implications:

• This case highlights the importance of considering parasitic infections in patients with unexplained arthritis and eosinophilia.
• The co-occurrence of parasitic infection and HLA B27 raises questions about the interplay between infectious agents and genetic predisposition in reactive arthritis.
• Further research is warranted to elucidate the potential causal link between Ankylostoma duodenale and B27-related arthropathy.