1
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Jin XY, Li DD, Quan W, Chao Y, Zhang B. Leaky gut, circulating immune complexes, arthralgia, and arthritis in IBD: coincidence or inevitability? Front Immunol 2024; 15:1347901. [PMID: 38571963 PMCID: PMC10987687 DOI: 10.3389/fimmu.2024.1347901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Most host-microbiota interactions occur within the intestinal barrier, which is essential for separating the intestinal epithelium from toxins, microorganisms, and antigens in the gut lumen. Gut inflammation allows pathogenic bacteria to enter the blood stream, forming immune complexes which may deposit on organs. Despite increased circulating immune complexes (CICs) in patients with inflammatory bowel disease (IBD) and discussions among IBD experts regarding their potential pathogenic role in extra-intestinal manifestations, this phenomenon is overlooked because definitive evidence demonstrating CIC-induced extra-intestinal manifestations in IBD animal models is lacking. However, clinical observations of elevated CICs in newly diagnosed, untreated patients with IBD have reignited research into their potential pathogenic implications. Musculoskeletal symptoms are the most prevalent extra-intestinal IBD manifestations. CICs are pivotal in various arthritis forms, including reactive, rheumatoid, and Lyme arthritis and systemic lupus erythematosus. Research indicates that intestinal barrier restoration during the pre-phase of arthritis could inhibit arthritis development. In the absence of animal models supporting extra-intestinal IBD manifestations, this paper aims to comprehensively explore the relationship between CICs and arthritis onset via a multifaceted analysis to offer a fresh perspective for further investigation and provide novel insights into the interplay between CICs and arthritis development in IBD.
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Affiliation(s)
- Xi-ya Jin
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dan-dan Li
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wei Quan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yang Chao
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Zhang
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
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2
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Zeidler H. [History of reactive arthritis. Historical milestones and future]. Z Rheumatol 2022; 81:692-698. [PMID: 36006472 PMCID: PMC9406267 DOI: 10.1007/s00393-022-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
The introduction of the term reactive arthritis (ReA) for the joint inflammation observed after infection with Yersinia enterocolitica, in which "a causative pathogen cannot be isolated from the synovial fluid", and the association with the HLA-B27 were the historical milestones for a new classification and assignment to the spondylarthritides (SpA). The division into postinfectious and reactive arthritis proposed in 1976 was put into perspective in the 1990s because of investigations with the newly available molecular biological method of the polymerase chain reaction. Microbial products could be identified from joint samples of patients with ReA. Therefore, it was proposed to abandon the distinction between the two groups of diseases and to prefer the term ReA for both. This created a terminological and nosological issue. On the one hand, there are generally accepted classification and diagnostic criteria for the classical HLA-B27-associated ReA that are assigned to SpA. On the other hand, an increasing number of bacterial pathogens, viruses, amoebas, helminths as well as antiviral and antibacterial vaccinations are described as triggers of arthritis, which have been published under the term ReA. Since the beginning of the SARS-CoV‑2 pandemic, cases of acute post-COVID-19 arthritis have been described, which were also classified as ReA because of comparable clinical features.
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Affiliation(s)
- H Zeidler
- Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Deutschland.
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3
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de los Mozos-Ruano A, Casas-Deza D, Calvo-Galindo R, García-López S. Artritis reactiva asociada a Clostridioides difficile: un caso clínico inusual y revisión de la literatura. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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de Los Mozos-Ruano A, Casas-Deza D, Calvo-Galindo R, García-López S. Clostridium difficile associated reactive arthritis: An unusual clinical case and review of the literature. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:338-339. [PMID: 35484065 DOI: 10.1016/j.eimce.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Diego Casas-Deza
- Grupo de investigación Biología del tejido adiposo y complicaciones metabólicas de la obesidad (ADIPOFAT), Servicio de Aparato Digestivo, Hospital Ernest Lluch Martin, Instituto de Investigación Sanitaria (IIS), Calatayud, Zaragoza, Spain
| | | | - Santiago García-López
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria (IIS), Zaragoza, Spain
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5
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Zimmermann O, Köchel H, Bohne W, Pollok-Kopp B, Passenberg P, Groß U. A Case Report and Review of the Literature: Reactive Arthritis Caused by Clostridioides difficile ribotype 027. Front Microbiol 2022; 13:837422. [PMID: 35250952 PMCID: PMC8888899 DOI: 10.3389/fmicb.2022.837422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 01/05/2023] Open
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.
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Affiliation(s)
- Ortrud Zimmermann
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Heinrich Köchel
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Bohne
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Beatrix Pollok-Kopp
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Passenberg
- St. Martini Hospital, Clinic for Internal Medicine and Gastroenterology, Duderstadt, Germany
| | - Uwe Groß
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
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6
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Zeidler H, Hudson AP. Reactive Arthritis Update: Spotlight on New and Rare Infectious Agents Implicated as Pathogens. Curr Rheumatol Rep 2021; 23:53. [PMID: 34196842 PMCID: PMC8247622 DOI: 10.1007/s11926-021-01018-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review This article presents a comprehensive narrative review of reactive arthritis (ReA) with focus on articles published between 2018 and 2020. We discuss the entire spectrum of microbial agents known to be the main causative agents of ReA, those reported to be rare infective agents, and those reported to be new candidates causing the disease. The discussion is set within the context of changing disease terminology, definition, and classification over time. Further, we include reports that present at least a hint of effective antimicrobial therapy for ReA as documented in case reports or in double-blind controlled studies. Additional information is included on microbial products detected in the joint, as well as on the positivity of HLA-B27. Recent Findings Recent reports of ReA cover several rare causative microorganism such as Neisseria meningitides, Clostridium difficile, Escherichia coli, Hafnia alvei, Blastocytosis, Giardia lamblia, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica/dispar, Strongyloides stercoralis, β-haemolytic Streptococci, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mycobacterium bovis bacillus Calmette-Guerin, and Rickettsia rickettsii. The most prominent new infectious agents implicated as causative in ReA are Staphylococcus lugdunensis, placenta- and umbilical cord–derived Wharton’s jelly, Rothia mucilaginosa, and most importantly the SARS-CoV-2 virus. Summary In view of the increasingly large spectrum of causative agents, diagnostic consideration for the disease must include the entire panel of post-infectious arthritides termed ReA. Diagnostic procedures cannot be restricted to the well-known HLA-B27-associated group of ReA, but must also cover the large number of rare forms of arthritis following infections and vaccinations, as well as those elicited by the newly identified members of the ReA group summarized herein. Inclusion of these newly identified etiologic agents must necessitate increased research into the pathogenic mechanisms variously involved, which will engender important insights for treatment and management of ReA. Supplementary Information The online version contains supplementary material available at 10.1007/s11926-021-01018-6.
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Affiliation(s)
- Henning Zeidler
- Division of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Alan P Hudson
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
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Reinholz A, Mannuru D, Bande D, Matta A. Reactive arthritis: an unusual presentation of acute Clostridioides difficile colitis. BMJ Case Rep 2021; 14:14/4/e240890. [PMID: 33795278 DOI: 10.1136/bcr-2020-240890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 20-year-old Caucasian man with a history of psoriasis presented to the emergency department due to a 2-week history of severe polyarthralgia and a 3-week history of non-bloody diarrhoea. The initial workup 2 days prior in an urgent care clinic returned negative for all enteric pathogens including Clostridioides difficile nucleic acid amplification test. Investigations revealed colitis on CT and pseudomembranous colitis on colonoscopy. The aspirate returned positive for C. difficile toxin. Tissue biopsies of the ascending, transverse, sigmoid colon and rectum were negative for chronicity to suggest inflammatory bowel disease with extraintestinal manifestation as the aetiology of polyarthralgia, which had been the most likely differential diagnosis until that point. The biopsy confirmed the diagnosis of reactive arthritis in the setting of C. difficile colitis. The patient improved on treatment with naproxen and was referred to rheumatology where he was found to be HLA-B27 positive.
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Affiliation(s)
- Anna Reinholz
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Devendranath Mannuru
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.,Internal Medicine, Sanford Medical Center, Fargo, North Dakota, USA
| | - Dinesh Bande
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.,Internal Medicine, Sanford Medical Center, Fargo, North Dakota, USA
| | - Abhisnek Matta
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA .,Internal Medicine, Sanford Medical Center, Fargo, North Dakota, USA
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8
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Septic arthritis post anterior cruciate ligament reconstruction due to Clostridioides difficile. Anaerobe 2020; 66:102293. [PMID: 33181347 DOI: 10.1016/j.anaerobe.2020.102293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022]
Abstract
Clostridioides difficile is an obligate anaerobe ubiquitous in the environment and is of particular interest in the healthcare setting as a cause of healthcare associated infection usually presenting with colitis. Extracolonic manifestations of C. difficile infection are less common with only rare reports of septic arthritis primarily in the setting of relative or overt immunocompromise. This report details the case of a 31-year-old immunocompetent male presenting with clinical features of septic arthritis, three weeks post right knee anterior cruciate ligament (ACL) reconstruction using a native hamstring tendon graft. C. difficile was isolated from two different samples of the synovial tissue from a subsequent arthroscopic washout and synovectomy. The ACL graft was retained. The isolate underwent whole genome sequencing and was found to be tcdA and tcdB gene deficient. Susceptibility testing showed susceptibility to benzylpenicillin and metronidazole. The patient received a two-week course of intravenous benzylpenicillin and four weeks of oral metronidazole. At one-year post cessation of antibiotics the patient has no clinical evidence of recurrence. This is the first known reported case of C. difficile septic arthritis in an immunocompetent patient. It demonstrates successful treatment of post-ACL septic arthritis with a graft retention strategy.
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9
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Molecular Characterization and Antibiotic Profile of Clostridium difficile Isolated from Bacteremia. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.83520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Cointe A, de Ponfilly GP, Munier AL, Bachir M, Benmansour H, Crémieux AC, Forien M, Frazier A, Krief E, Cambau E, Jacquier H. Native joint septic arthritis due to Clostridium tarantellae. Anaerobe 2019; 56:46-48. [PMID: 30753899 DOI: 10.1016/j.anaerobe.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
Clostridium is a diverse genus including more than 200 species involved in varied clinical presentations in infectious diseases. Septic arthritis caused by Clostridium sp. are however uncommon. We report here the first septic arthritis due to Clostridium tarantellae, formerly called Eubacterium tarantellae, in a patient under anti-TNF therapy.
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Affiliation(s)
- Aurélie Cointe
- Laboratory of Microbiology, Department of Infectious Agents, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Gauthier Péan de Ponfilly
- Laboratory of Microbiology, Department of Infectious Agents, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Anne-Lise Munier
- Department of Infectious Diseases, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Marwa Bachir
- Department of Infectious Diseases, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Hanaa Benmansour
- Laboratory of Microbiology, Department of Infectious Agents, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Anne-Claude Crémieux
- Department of Infectious Diseases, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Marine Forien
- Department of Rhumatology, Bichat-Claude Bernard University Hospital, APHP, Paris, France
| | - Aline Frazier
- Federation of Rheumatology, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Elie Krief
- Department of Orthopaedic Surgery, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France
| | - Emmanuelle Cambau
- Laboratory of Microbiology, Department of Infectious Agents, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Hervé Jacquier
- Laboratory of Microbiology, Department of Infectious Agents, Saint Louis - Lariboisiere - Fernand Widal University Hospital, APHP, Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
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11
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Bozzao F, Bernardi S, Dore F, Zandonà L, Fischetti F. Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature. BMC Musculoskelet Disord 2018; 19:145. [PMID: 29759083 PMCID: PMC5952696 DOI: 10.1186/s12891-018-2068-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/30/2018] [Indexed: 01/05/2023] Open
Abstract
Background Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by abnormal proliferation of skin and periosteal tissues of the extremities. It can be a rare hereditary disease (pachydermoperiostosis) or can be secondary to various diseases, though mostly lung malignancies. Here, we report an unusual clinical presentation of HOA. Case presentation A 77-year-old man presented with fever, diarrhea, and an oligoarthritis involving the left knee and the ankles. Since left knee synovial fluid aspiration revealed an aseptic synovitis and Clostridium Difficile toxin was detectable in stool samples, a reactive arthritis secondary to a Clostridium Difficile induced colitis was initially suspected. However, the presence of a worsened digital clubbing and the lack of a good clinical response to steroid therapy led us to perform a radionuclide bone scanning, which revealed HOA. This turned out to be associated with a lepidic predominant lung adenocarcinoma, which was clinically and radiologically difficult to distinguish from a relapse of pneumonia. Conclusion Consistent with the literature, HOA tends to have a variable clinical presentation, mimicking that of various rheumatic diseases. This clinical case shows that HOA can present as a presumptive acute reactive arthritis, and it highlights the importance of patient’s follow-up in the differential diagnosis of inflammatory arthritis, especially when a worsened digital clubbing is present.
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Affiliation(s)
- Francesco Bozzao
- Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 449, 34149, Trieste, Italy.
| | - Stella Bernardi
- Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 449, 34149, Trieste, Italy
| | - Franca Dore
- ASUITS, Cattinara Teaching Hospital, Strada di Fiume 449, 34149, Trieste, Italy
| | - Lorenzo Zandonà
- ASUITS, Cattinara Teaching Hospital, Strada di Fiume 449, 34149, Trieste, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 449, 34149, Trieste, Italy
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12
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Marwat A, Mehmood H, Hussain A, Khan M, Ullah A, Joshi M. Clostridium difficile Colitis Leading to Reactive Arthritis: A Rare Complication Associated With a Common Disease. J Investig Med High Impact Case Rep 2018; 6:2324709618767689. [PMID: 29623279 PMCID: PMC5881974 DOI: 10.1177/2324709618767689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/04/2023] Open
Abstract
The relationship between reactive arthritis and enteric infections caused by Yersinia enterocolitica, Campylobacter jejuni, and Salmonella typhimurium is well documented. Clostridium difficile colitis is a less recognized cause of reactive arthritis. We present a case of a 58-year-old woman with Clostridium difficile colitis complicated by reactive arthritis. A 58-year-old woman with no significant past medical history presented to our hospital with complaints of nonbloody watery diarrhea, abdominal pain for the past 1 week, and right knee pain starting 1 day prior. The patient had recently used antibiotics for a respiratory tract infection. On examination, the patient had a swollen and erythematous right knee. While in the hospital the patient also developed a similarly painful and swollen left knee. The patient was found to be positive for C difficile toxin in stool. Synovial fluid analysis of both the knee joints revealed a sterile and inflammatory fluid, negative for crystals and showing no growth on gram stain. We diagnosed the patient with reactive arthritis secondary to C difficile colitis once all other causes of the bilateral knee joint symptoms were ruled out with appropriate laboratory and imaging studies. Treatment with oral vancomycin and an anti-inflammatory was initiated, and the patient had complete resolution of symptoms. This case illustrates the importance of recognizing C difficile colitis as a potential differential for reactive arthritis under the appropriate circumstances. The treatment of reactive arthritis is mainly supportive and treating the underlying cause, which happens to be C difficile in this case.
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Affiliation(s)
- Asghar Marwat
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Hassan Mehmood
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Ali Hussain
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Muzammil Khan
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Asad Ullah
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Medha Joshi
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Medical Center, Johnstown, PA, USA
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13
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Hill E, Workman AD, Lee F, Hollaway R, Cavuoti D, Prokesch BC. Bacteremia and Septic Arthritis due to a Nontoxigenic Strain of Clostridium difficile in a Patient With Sickle Cell Disease. Open Forum Infect Dis 2018; 5:ofx278. [PMID: 29410974 PMCID: PMC5793821 DOI: 10.1093/ofid/ofx278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/29/2017] [Indexed: 12/23/2022] Open
Abstract
A 22-year-old female with sickle cell disease presented with fevers, bilateral knee pain, and lethargy. Laboratory data revealed a leukocytosis and lactic acidosis. Blood and synovial fluid cultures grew a non-toxin-producing strain of Clostridium difficile. This case highlights the fact that nontoxigenic Clostridium difficile can cause significant disease.
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Affiliation(s)
- Emilie Hill
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrienne D Workman
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Francesca Lee
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rita Hollaway
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dominick Cavuoti
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bonnie C Prokesch
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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