Abstract
Reactive arthritis (ReA) following bacterial infection from the urogenital and gastrointestinal tract is widely described but is not typical post-viral infections. This report presents the second case of ReA after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States. A 45-year-old black male with chronic low back pain was hospitalized for 45 days with coronavirus disease 2019 (COVID-19), complicated due to the development of multiorgan failure managed with intubation, extracorporeal membrane oxygenation, and hemodialysis. He was subsequently discharged to an acute rehabilitation facility where he complained of new-onset pain in his shoulders, left elbow, and left knee three weeks after a negative SARS-CoV-2 test. He was readmitted from his acute rehabilitation facility due to recurrent fever and the development of a swollen, warm left knee. Laboratory studies at readmission showed elevated inflammatory markers, negative extensive infectious disease workup, and aseptic inflammatory left knee synovial fluid without crystals. Testing returned negative for most common antibodies seen in immune-mediated arthritides (e.g., rheumatoid arthritis, systemic lupus erythematosus), as well as for common respiratory and gastrointestinal tract pathogens responsible for viral arthritis. The multidisciplinary inpatient medical team deemed the clinical presentation and laboratory findings most consistent with ReA. The patient received a course of oral corticosteroids, followed by a second course due to the recurrence of symptoms weeks after initial treatment and recovery. The current body of medical literature on SARS-CoV-2 pathophysiology supports plausible mechanisms on how this infection may induce ReA. Such a scenario should be considered in the differential of COVID-19-recovered patients presenting with polyarthritis as prompt steroid treatment may help patient recovery.
Highlights
Patients with reactive arthritis (ReA) typically present with aseptic oligoarthritis one to six weeks after extra-articular infection, usually of gastrointestinal or urogenital origin [1]
This report presents the second case of Reactive arthritis (ReA) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States
A 45-year-old black male with chronic low back pain was hospitalized for 45 days with coronavirus disease 2019 (COVID-19), complicated due to the development of multiorgan failure managed with intubation, extracorporeal membrane oxygenation, and hemodialysis
Summary
Patients with reactive arthritis (ReA) typically present with aseptic oligoarthritis one to six weeks after extra-articular infection, usually of gastrointestinal or urogenital origin [1]. A 45-year-old black male with a family history of hypertension and prostate cancer, a personal history of chronic low back pain status post spinal fusion, and a recent 45-day hospitalization for COVID-19 pneumonia developed a new-onset polyarthritis three days after his discharge to acute inpatient rehabilitation His COVID-19 syndrome consisted of a five-day history of productive cough and fever with a real-time polymerase chain reaction (RT-PCR) of his nasal swab positive for SARS-CoV-2. He later developed multiorgan failure during his hospitalization, which required 21 days of intubation with prone positioning, 16 days of veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy He had two negative repeat testing for SARS-CoV-2 on days 27 and 31. Given his recent renal impairment, they started him on a tapered dose of oral corticosteroid with significant improvement in pain and resolution of fever
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