Reactive arthritis due to Salmonella enteritidis complicated by carditis

Salmonella Typhimurium Myocarditis in Two Previously Healthy Children

Myocarditis represents an inflammation affecting the heart muscles, a condition relatively uncommon among children. Its diagnosis poses challenges due to the diverse range of its non-specific symptoms. Non-typhoidal Salmonella (NTS) species are known as rare but noteworthy contributors to myocarditis, especially among immunocompetent young patients. We present two cases of NTS myocarditis in previously healthy children, in an attempt to shed light on the epidemiology, diagnostic methods, and prognosis, aiming to offer a greater understanding of this rare condition.

Aortic insufficiency in a patient with reactive arthritis: case report and review of the literature

BACKGROUND

Reactive arthritis (ReA) consists of the classic clinical triad of arthritis, urethritis, and conjunctivitis generally occurring within 6 weeks of an infection, typically of the gastrointestinal or genitourinary systems. Cardiovascular manifestations of ReA and other members of the spondyloarthritis family have long been recognized.

CASE REPORT

A 43-year-old male who was human leukocyte antigen-27 (HLA-B27)-positive and who had ReA for 19 years developed severe aortic insufficiency requiring aortic valve replacement. Typically, the onset of musculoskeletal symptoms precedes development of aortic insufficiency by many years. The average calculated from reported cases was 13 years, with a range from 4 days to 61 years. The mechanism by which the aortic valve leaflets become targets in HLA-B27-associated disease is unclear. At one point, interest developed as to whether the HLA-B27 allele was independently associated with lone aortic insufficiency, in the absence of clinical spondylitis. The preponderance of cardiac abnormalities in patients with HLA-B27-positive ReA has led to the suggestion that a genetic syndrome of the heart consisting of aortic insufficiency and conduction-system abnormalities exists, and has been dubbed the "HLA-B27-associated cardiac syndrome". This case highlights the importance of recognizing the association between HLA-B27-associated spondyloarthritis and serious aortic valvular complications.

CONCLUSION

Clinicians should maintain a high suspicion for aortic insufficiency in patients with ReA, including a low threshold for echocardiographic evaluation. A heightened awareness can lead to earlier identification and potential avoidance of fatal events in these patients.

The spectrum of skin, mucosa and other extra-articular manifestations

The seronegative spondyloarthropathies appear to be the genetically predisposed host's clinical expression to acute, subacute or chronic reaction to the invasion by environmental microorganisms. In the ensuing days or weeks, depending on the infectious load, clinical manifestations may occur ranging from constitutional complaints such as fever, to a variety of symptoms and/or signs related to the portal of entry-intestinal, genitourinary or respiratory. Within weeks or months, the initial or other target organs, such as the mucocutaneous, ocular and cardiovascular systems, may develop an acute reaction of greater or lesser specificity regarding the triggering agent (oral ulcers, circinate balanitis, erythema nodosum, acute anterior uveitis, pericarditis, heart blocks). Lastly, many years later, a minority of patients, probably those with a large genetic component, exhibit a spectrum of clinical manifestations related to those organs, with a chronic or recurrent course. Acute clinical manifestations--reactive arthritis--are prominent in the initial phase of the clinical spectrum, while chronic manifestations--ankylosing spondylitis--are seen at the other end of the spectrum.