Clostridium difficile Colitis Leading to Reactive Arthritis: A Rare Complication Associated With a Common Disease.

Asghar Marwat,Medha Joshi,Hassan Mehmood,Ali Hussain,Asad Ullah,Muzammil Khan

doi:10.1177/2324709618767689

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.

Highlights

Reactive arthritis typically manifests as an acute aseptic, inflammatory, asymmetric oligoarthritis commonly affecting the large joints of the lower extremities
We present a case of a 58-year-old woman with C difficile colitis complicated by reactive arthritis
According to the Center for Diseases Control and Prevention, C difficile was responsible for almost half a million infections, resulting in roughly 29 000 deaths in 2011.7 C difficile infection most commonly leads to pseudomembranous colitis, which presents itself as fever and diarrhea starting from 4 to 9 days after starting antibiotic treatment.[8]

Summary

Introduction

Reactive arthritis typically manifests as an acute aseptic, inflammatory, asymmetric oligoarthritis commonly affecting the large joints of the lower extremities. The patient had an acute onset of severe, nontraumatic right knee pain, with redness and swelling of the joint for the past day She has nonbloody, watery diarrhea going on for the past 1 week with maximum episodes up to 10 in a day. Journal of Investigative Medicine High Impact Case Reports upper respiratory tract infection 3 weeks ago before this presentation and completed 10 days of oral cefuroxime subsequently On physical examination, she was afebrile with a temperature of 99.5°F, blood pressure of 156/68 mm Hg, and pulse of 87 beats per minute. Her pain was getting worse, and the day she had mild to moderate discomfort in the left knee with restricted range of motion. She was discharged subsequently and seen in the clinic after 4 weeks later with the knee pain resolved and return to full functional capacity

Discussion

Conclusion