Slouma Maroua, Ben Dhia Siwar, Dhahri Rim, Litaiem Noureddine, Metoui Leila, Gharsallah Imen, Louzir Bassem
Department of Rheumatology Military Hospital Tunis Tunisia.
Tunis El Manar University Tunis Tunisia.
Clin Case Rep. 2022 Nov 6;10(11):e6542. doi: 10.1002/ccr3.6542. eCollection 2022 Nov.
Reactive arthritis is a rare form of spondyloarthropathies occurring after genital or enteric infection. It is most often self-limited but can progress to chronic spondylarthritis. We report the case of a 30-year-old man who presented with acute arthritis occurring 2 months after an episode of urethral discharge. Physical examination revealed polyarthritis, dactylitis, sacroiliac joint involvement, and plantar papulosquamous plaques. The human leukocyte antigen B27 was positive. Detection of and in the first catch urine specimen was negative. Hepatitis B and C, , human immunodeficiency virus, and syphilis serologic test results were negative. Pelvic magnetic resonance imaging revealed left sacroiliitis. The patient was treated with antibiotics, diclofenac, and sulfasalazine. After 6 months of follow-up, a significant clinical improvement was obtained without remission, suggesting an evolution to chronic spondylarthritis. Diagnosis of Reactive arthritis is difficult since microbiologic examinations are commonly negative. This disease should be considered in patients with rheumatologic manifestations occurring after a urogenital or enteric infection, mainly when associated with skin manifestations and human leukocyte antigen B27.
反应性关节炎是一种罕见的脊柱关节炎,发生于生殖器或肠道感染之后。它通常具有自限性,但可进展为慢性脊柱关节炎。我们报告一例30岁男性病例,该患者在尿道分泌物出现2个月后出现急性关节炎。体格检查发现多关节炎、指(趾)炎、骶髂关节受累以及足底丘疹鳞屑性斑块。人类白细胞抗原B27呈阳性。首次晨尿标本中检测沙眼衣原体和淋病奈瑟菌均为阴性。乙肝、丙肝、巨细胞病毒、人类免疫缺陷病毒以及梅毒血清学检测结果均为阴性。盆腔磁共振成像显示左侧骶髂关节炎。该患者接受了抗生素、双氯芬酸和柳氮磺胺吡啶治疗。经过6个月的随访,患者临床症状有显著改善但未缓解,提示已演变为慢性脊柱关节炎。由于微生物学检查通常为阴性,反应性关节炎的诊断较为困难。对于在泌尿生殖系统或肠道感染后出现风湿病表现的患者,尤其是伴有皮肤表现和人类白细胞抗原B27阳性时,应考虑本病。