SHM Converge Scientific Abstract ePoster Gallery-Loose Stools and Swollen Joints: A Reminder to Keep a Broad "Diff"erential

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A 51-year-old man with irritable bowel syndrome presented with three weeks of non-bloody diarrhea followed by five days of progressive polyarthralgias affecting the wrist, fingers, elbows, ankles, and knees bilaterally, with the right MCP joints and right knee most involved. Initial workup showed leukocytosis, elevated lactate, and high CRP. Common infectious causes of reactive arthritis were negative, but stool testing was positive for Clostridioides difficile toxin and antigen. Autoimmune testing was largely unrevealing.<br /><br />He was treated with oral vancomycin for C. difficile infection and NSAIDs for arthritis, with improvement by discharge. His joint symptoms briefly worsened after discharge, prompting a short prednisone taper. At rheumatology follow-up two months later, both diarrhea and arthritis had fully resolved.<br /><br />The case highlights C. difficile as an uncommon but important cause of reactive arthritis. While reactive arthritis is classically linked to GI pathogens such as Yersinia, Salmonella, Shigella, and Campylobacter, C. difficile is increasingly recognized and may be overlooked, especially when diarrhea is mild. Unlike many other infectious triggers, all C. difficile infections require antibiotic treatment. Management of the arthritis follows standard reactive arthritis care, beginning with NSAIDs and escalating to corticosteroids or disease-modifying agents if needed. The authors emphasize that clinicians evaluating patients with unexplained arthritis and diarrhea should include C. difficile in the differential diagnosis.

Asset Subtitle

Joshua LaBrin

Meta Tag

Author List Gregory Toy, Jay DuBroff, Joshua LaBrin

Category Clinical Vignettes

Concept Clostridioides difficile Infection

Concept Reactive Arthritis

Concept Diarrhea

Concept Inflammatory joint symptoms

Concept Gastrointestinal Infection

Distinguished Non-Finalist

Presenter Organization University of Utah, Department of Internal Medicine

Presenting Author Joshua LaBrin

Track Adult

Keywords

Clostridioides difficile

reactive arthritis

diarrhea

polyarthralgia

NSAIDs

oral vancomycin

prednisone taper

irritable bowel syndrome

stool toxin test

gastrointestinal infection

Clostridioides difficile Infection

Reactive Arthritis

Diarrhea

Inflammatory joint symptoms

Gastrointestinal Infection