387. A Rare Manifestation of a Common Disease: Tenosynovitis Associated with Clostridium difficile: Case Report and Review of Literature

Abstract

BackgroundReactive arthritis typically develops following enteric or genitourinary infection. The most common offending pathogens are Chlamydia, Salmonella, Shigella, Yersinia and Campylobacter. We report a unique case of a patient with tenosynovitis attributed to Clostridium difficile (C. difficile), and review of the literature.MethodsWe searched PubMed for “reactive arthritis” and “C. difficile” and found 53 cases. Two additional cases were excluded as they were published in French.ResultsAn 18-year-old healthy male presented with nine days of abdominal pain and diarrhea, and two days of pain and swelling of bilateral fingers with an erythematous/ecchymotic rash over the second and third digits. Four weeks prior to symptom onset he received antibiotics for streptococcal pharyngitis. On presentation he had diffuse abdominal tenderness and edema of the PIP/DIP joints with tenderness throughout the phalangeal soft tissue, consistent with tenosynovitis. He had a leukocyte count of 33.0 thou/ μL and C-reactive protein of 12.0 mg/dL (normal < 1.0 mg/dL). C. difficile toxin PCR was positive, toxin EIA was negative. CT scan of the abdomen/pelvis demonstrated mural thickening consistent with extensive severe colitis. He received 14 days of oral vancomycin, with complete symptom resolution, including the tenosynovitis. Our literature review revealed 22.6% (12/53) of cases had involvement of hands, although all also had involvement of other joints. Our patient’s isolated tenosynovitis of bilateral hands is unique, and has only been reported once prior to our knowledge. Literature suggests treatment of the underlying C. difficile infection should result in rapid clinical improvement of tenosynovitis symptoms, as in our patient.Conclusion C. difficile continues to pose a significant threat to health and burden on the healthcare system. The association of reactive arthritis and C. difficile was first reported in 1976, with only 53 subsequent cases reported. Reactive arthritis classically presents as asymmetrical oligo- or polyarthritis involving lower extremities or large joints. Our case demonstrates isolated tenosynovitis of the hands may also be a possible presentation. Given the continued rise of C. difficile, it is imperative that this pathogen is considered in such cases.Disclosures All authors: No reported disclosures.