An unusual cause of reactive arthritis with urticarial: A case report

Abstract

Reactive arthritis (ReA) is a syndrome of arthritis and tenosynovitis with defined extra-articular manifestations following certain infections. Despite being recognized a long time ago, debates still surrounds its definition. It is still unclear if the spectrum of the disease should include arthritis induced by other than the classical organisms. Here, we present an unusual cause of ReA. A young healthy female patient presented with acute polyarthritis and acute urticaria after 2 weeks of diarrheal illness. She was found to have blastocystis in the stool microscopy. Extensive evaluation ruled out other causes of her arthritis. She received metronidazole with a short course of NSAIDS and steroids with complete resolution of her skin and joint symptoms. She was followed for six months with no recurrence of arthritis or urticaria. Blastocystis sp. is a parasite that is prevalent in developing countries. It has been linked to isolated ReA or isolated urticaria among a few other case reports. This is the very first case to have blastocystis induced ReA that coexisted with acute urticaria. Upon review of the literature, we found that blastocystis induced ReA affects mainly young and middle-aged females such as in our case. The arthritis is usually settled with the parasite eradication. Finally, urticaria might be a distinguishing feature for blastocystis induced ReA that requires specific antimicrobial therapy.

A case of reactive arthritis caused by a perianal abscess

“…ReA is not uncommon, and many infectious agents can cause ReA, such as bacteria, helminths, viruses, amoeba, vaccinations, and protozoa. 14 Recent articles described chronic asymptomatic prostatitis (Neisseria meningitidis infection) associated with chronic ReA and the first case of ReA with urticaria caused by Blastocystis, 15,16 and we found ReA can also be caused by the infection of perianal abscesses. This article presented a patient with unexplained polyarticular swelling and pain, subcutaneous hematoma of the right knee joint, and the right ankle joint fluid; MRI examination suggested noninfectious inflammatory arthritis, and no evidence of other infectious agents was found; later, the patient developed a perianal abscess.…”

Protozoan Infections Acquired from Food or Drinking Water: An Update

“…The paucity or lack of reports for B. hominis, E. nana, D. fragilis and P. hominis reflects the poorly defined role of these species as pathogens. However, further investigation should consider evaluating their occurrence in cases with symptoms found to be associated with these organisms, such as urticaria-like reactions [253,254,262].…”

“…The identified sources of the infection cases and outbreaks most recently reported for waterborne and foodborne parasitic protozoans are shown in Table 1. [8,9,19,35,36,45,47,64,66,68,69,72,110,125,126,132,133,146,151,152,162,[169][170][171][172][173]178,185,186,199,200,205,207,209,211,218,220,221,228,254,255,262].…”

“…was detected in the patient's feces. She completely recovered after administration of metronidazole, naproxen and prednisolone [254].…”

Decreased fecal calprotectin levels in Spondyloarthritis patients colonized by Blastocystis spp.

“…There are only a few known case reports that point to Blastocystis spp. 14 , 15 , Cryptosporidium 16 , 17 , Dracunculus 18 , Endolimax nana 19 , Entamoeba hartmanni 20 , Entamoeba histolytica 19 , 21 , Giardia intestinalis 22 – 24 , Strongyloides stercoralis 19 , 25 , 26 and Taenia saginata 19 , 25 as causal agents of ReA. Some reports propose Toxoplasma gondii as a triggering agent of ReA 19 but more recent studies suggest these findings may be coincidental 27 .…”