Run Time: 5 minutes
Author: Peter Bakes M.D.
- Case presentation: 18 year old otherwise healthy male presents to the ED complaining of neck stiffness, headache, and right ankle irritation. The patient recently traveled to Italy in an area endemic of Lyme Disease. The patient 2 weeks prior had a viral infection w/ rhinorrhea and diarrhea. The patient was diagnosed the previous day with a “UTI” and is currently taking antibiotics.
- Other important information that would be useful for evaluation would be a prior evaluation for lyme, known pre-existing joint processes, and previous rheumatoid history.
- The patient had no rash on exam, no associate features of lyme, and no bacteria in the urine, but had noted unilateral conjunctivitis, and a red, inflamed ankle joint.
- Possible causes of presentations of one red, warm, inflamed painful joint: Gouty arthritis, pseudogout, septic joint, lyme arthritis, acute on chronic arthritis, and reactive arthritis.
- This patient was diagnosed with Reiter’s syndrome now known as a reactive arthritis – an antibody response to an infection. Classically presents as a genitourinary or gastrointestinal infection in a young male with the clinical triad of urethritis, conjunctivitis, and arthritis a few weeks after an infection.