SHM Converge Scientific Abstract ePoster Gallery-From Lungs to Joint: A Rare Respiratory Viral Trigger for Reactive Arthritis

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This case describes a healthy 34-year-old woman with 4 days of severe acute left hip/thigh pain, fever/chills, and inability to bear weight. Exam showed marked pain with hip movement and tenderness, but no trauma, erythema, or fluctuance. Workup revealed elevated ESR/CRP, normal CBC/CMP/CK, negative blood and urine cultures, negative gonorrhea/chlamydia testing, negative autoimmune labs, and normal X-rays. MRI showed only a small hip effusion and mild periarticular changes. Arthrocentesis yielded cloudy fluid with 35,000 WBCs and 85% neutrophils, but no crystals, negative Gram stain, and negative culture.<br /><br />The presentation was ultimately most consistent with reactive arthritis, which is a clinical diagnosis made after ruling out septic and crystal arthritis. This case is notable because the suspected trigger was a respiratory viral infection, with rhinovirus/enterovirus PCR positivity, which is rare but possible. HLA-B27 was negative, emphasizing that reactive arthritis can still occur without this marker.<br /><br />Reactive arthritis should be considered in patients with acute oligoarthritis after recent gastrointestinal, genitourinary, or respiratory infection, even when common pathogens are not found. Common triggers include:<br />- Gastrointestinal: Salmonella, Shigella, Campylobacter, Yersinia<br />- Genitourinary: Chlamydia trachomatis<br /><br />Less common or uncommon triggers can include:<br />- Respiratory pathogens: Chlamydia pneumoniae, and rarely viral infections such as rhinovirus/enterovirus<br />- Other reported infectious triggers may occur, but are much less typical<br /><br />Treatment in this case began with empiric antibiotics for possible septic arthritis, but after negative cultures and evaluation by rheumatology, therapy shifted to IV methylprednisolone, NSAIDs, and a prednisone taper, with clinical improvement.<br /><br />Overall, the case highlights that reactive arthritis can present as severe monoarthritis/oligoarthritis and may be triggered by infections outside the classic GI and GU causes.

Asset Subtitle

Luke Vest

Meta Tag

Author List Luke Vest, Sanjna Surya, Vatsal Y. Bhatt, William Mannherz

Category Clinical Vignettes

Concept Reactive Arthritis

Concept Clinical Diagnosis

Concept Synovial Fluid Analysis

Concept Septic Arthritis

Concept Crystalline Arthropathy

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Luke Vest

Track Adult

Keywords

reactive arthritis

acute monoarthritis

hip effusion

septic arthritis differential

rhinovirus

enterovirus

HLA-B27 negative

arthrocentesis

inflammatory synovial fluid

respiratory infection trigger

Reactive Arthritis

Clinical Diagnosis

Synovial Fluid Analysis

Septic Arthritis

Crystalline Arthropathy