SHM Converge Scientific Abstract ePoster Gallery-Oligoathralgia, Inflammatory Arthritis, Epidural Abscess: Can Chlamydia Do It All?

Pdf Summary

This case describes a 34-year-old man with methamphetamine use who presented with one week of neck, shoulder, and wrist pain, fevers, chills, myalgias, arthralgias, and new confusion. On exam he had nuchal rigidity, cervical spine tenderness, upper extremity weakness, and an inflamed wrist and ankles. Labs showed marked leukocytosis and elevated CRP. Arthrocentesis of the wrist and ankle was performed, and imaging of the cervical spine revealed a C3-T2 fluid collection consistent with a cervical spinal epidural abscess (SEA), prompting emergent laminectomy and washout.<br /><br />Despite severe inflammatory findings, cultures from blood, urine, synovial fluid, and epidural fluid were all negative. However, urine testing was positive for Chlamydia trachomatis, while gonorrhea testing was negative, including oral and rectal samples. Synovial fluid from the left wrist was low in WBCs, whereas the ankle fluid showed a strongly inflammatory pattern, supporting concern for reactive/infectious arthritis.<br /><br />The authors discuss that reactive arthritis, most commonly triggered by Chlamydia trachomatis, is a post-infectious inflammatory arthritis classically associated with urogenital or enteric infection. Although SEA due to chlamydia or reactive arthritis has not been previously reported, they suggest this may represent an under-recognized syndrome. They also note that disseminated gonococcal infection (DGI) can cause septic arthritis and abscesses, but diagnosis is challenging because cultures and Gram stains are often negative. Since chlamydia and gonorrhea frequently coexist, DGI could not be excluded.<br /><br />The patient was treated empirically with ceftriaxone and doxycycline, along with anti-inflammatory therapy for reactive arthritis. He was later discharged on doxycycline and levofloxacin for six weeks but was lost to follow-up.<br /><br />Overall, the case highlights the need to consider gonorrhea and chlamydia in culture-negative abscess syndromes, especially SEA with inflammatory arthritis.

Asset Subtitle

Jules Tabilona

Meta Tag

Author List Anandi Sheth, Elizabeth Trandel, Gabrielle Gundermann, Jules Tabilona, Jung M. Park, Lakshmi Katta

Category Clinical Vignettes

Concept Spinal Epidural Abscess

Concept Reactive Arthritis

Concept Septic Arthritis

Concept Inflammatory Arthritis

Concept Sexually Transmitted Infection

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Jules Tabilona

Track Adult

Keywords

methamphetamine use

cervical spinal epidural abscess

reactive arthritis

Chlamydia trachomatis

disseminated gonococcal infection

culture-negative infection

septic arthritis

arthrocentesis

ceftriaxone

doxycycline

Spinal Epidural Abscess

Reactive Arthritis

Septic Arthritis

Inflammatory Arthritis

Sexually Transmitted Infection