Reactive arthritis due to asymptomatic Escherichia coli bacteriuria in a young tuberculosis patient

Abstract

Reactive arthritis (ReA) is commonly associated with gastroenteritis by Yersinia, Salmonella, Shigella, Campylobacter, and Clostridium difficile and genitourinary infections by Chlamydia trachomatis and Neisseria gonorrhea. Urinary tract infection (UTI) with Escherichia coli is rarely associated with ReA. Failure to screen for UTI, especially in patients with asymptomatic bacteriuria, can lead to delayed diagnosis and inappropriate treatment. A 31-year-old homemaker, who had been diagnosed with pulmonary TB 1 month back and had completed 1 month of successful anti-TB therapy, presented with pain and swelling of the right knee and fever of 1-week duration. She had healing erythema nodosum on both her thighs. Her right knee had pain and swelling that lead to restriction of movements. X-ray of the right knee showed joint effusion with no joint destruction. Work up for autoimmune arthritis was negative. Synovial fluid studies ruled out septic arthritis, crystal arthropathies, and tuberculous arthritis. Urinalysis suggested UTI and urine culture isolated E. coli. Hence, we made the diagnosis of ReA due to UTI with E. coli. She received oral nonsteroidal anti-inflammatory drugs and a course of ciprofloxacin. She had a complete recovery.