Paul Legendre1, Valérie Lalande2, Catherine Eckert3, Fréderic Barbut4, Laurence Fardet5, Jean-Luc Meynard1, Laure Surgers6. 1. Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Saint-Antoine, Paris, France. 2. Laboratoire de Microbiologie, APHP, Hôpital Saint-Antoine, Paris, France. 3. Laboratoire Clostridium difficile associé au Centre National de Référence des Bactéries Anaérobies, APHP, Hôpital Saint-Antoine, Paris, France. 4. Laboratoire de Microbiologie, APHP, Hôpital Saint-Antoine, Paris, France; Laboratoire Clostridium difficile associé au Centre National de Référence des Bactéries Anaérobies, APHP, Hôpital Saint-Antoine, Paris, France. 5. Service de Médecine Interne, APHP, Hôpital Saint-Antoine, Paris, France. 6. Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Saint-Antoine, Paris, France; Sorbonne University, UPMC University Paris 06 CR7, Paris, INSERM U1135, CIMI, Team E13, France. Electronic address: laure.surgers@aphp.fr.
Abstract
INTRODUCTION: Extra-gastro-intestinal tract manifestations associated with Clostridium difficile infection (CDI), including reactive arthritis (ReA), are uncommon. METHOD: We report a case of ReA associated with a relapse of CDI in a 46-year-old woman. A toxigenic C. difficile strain was isolated from stools and characterized as PCR-ribotype 014/020/077. We conducted a comprehensive literature review of ReA associated with CDI (ReA-CDI). Diagnostic criteria for ReA-CDI were: (i) evidence of aseptic synovitis (confirmed by culture) developing during or immediately after colitis, (ii) presence of a toxigenic C. difficile strain in stool samples, and (iii) absence of other causes of colitis and arthritis. RESULTS: Forty-nine cases of ReA-CDI (excluding the present report) have already been described since 1976. Of these reports, Mean age of patients was 38 years (SD: 18.5), 46% were male, and 68% had HLA B27 genotype. Sixty-nine percent of patients received a β-lactamin treatment before CDI. ReA-CDI occurred a median 10 days (range 0-55 days) after CDI. Outcome was favorable in 90% of patients and oral non anti-inflammatory drugs were required for 55%. CONCLUSION: ReA-CDI remains uncommon. Compared to the general population, it is more likely observed in younger patients with HLA B27-positive genotype.
INTRODUCTION: Extra-gastro-intestinal tract manifestations associated with Clostridium difficileinfection (CDI), including reactive arthritis (ReA), are uncommon. METHOD: We report a case of ReA associated with a relapse of CDI in a 46-year-old woman. A toxigenic C. difficile strain was isolated from stools and characterized as PCR-ribotype 014/020/077. We conducted a comprehensive literature review of ReA associated with CDI (ReA-CDI). Diagnostic criteria for ReA-CDI were: (i) evidence of aseptic synovitis (confirmed by culture) developing during or immediately after colitis, (ii) presence of a toxigenic C. difficile strain in stool samples, and (iii) absence of other causes of colitis and arthritis. RESULTS: Forty-nine cases of ReA-CDI (excluding the present report) have already been described since 1976. Of these reports, Mean age of patients was 38 years (SD: 18.5), 46% were male, and 68% had HLA B27 genotype. Sixty-nine percent of patients received a β-lactamin treatment before CDI. ReA-CDI occurred a median 10 days (range 0-55 days) after CDI. Outcome was favorable in 90% of patients and oral non anti-inflammatory drugs were required for 55%. CONCLUSION:ReA-CDI remains uncommon. Compared to the general population, it is more likely observed in younger patients with HLA B27-positive genotype.