SHM Converge Scientific Abstract ePoster Gallery-Reactive Arthritis in a Patient With Hiv/Aids: A Diagnostic Conundrum

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This case report describes a 27-year-old man with untreated or newly recognized HIV infection who presented with 4 days of fever, severe mid-sternal chest pain, bilateral conjunctivitis, diarrhea, and asymmetric arthritis involving the right knee, left ankle, and left sacroiliac joint. Because HIV-associated arthropathy can closely resemble reactive arthritis (ReA), the team performed a broad diagnostic workup to distinguish between the two.<br /><br />Reactive arthritis is an inflammatory oligoarthritis that typically occurs 1–6 weeks after a gastrointestinal or genitourinary infection and may include conjunctivitis, urethritis, diarrhea, and mucocutaneous findings. In HIV-positive patients, extra-articular manifestations and atypical presentations can make diagnosis difficult. This patient had no genitourinary symptoms, showing that absence of the classic Reiter’s syndrome triad does not exclude ReA.<br /><br />The workup revealed a positive 4th-generation HIV test, viral load of 65,073 copies, and CD4 count of 91 cells/mm3. Initial tests for other infections and rheumatologic causes were negative, including blood cultures, rheumatoid factor, anti-CCP, and several infectious studies. Diagnosis of ReA was confirmed on hospital day 4 when a rectal swab returned positive for Chlamydia. He was treated with doxycycline, naproxen, antiretroviral therapy, and additional antibiotics while inpatient. His arthritis improved, and he was discharged after 6 days, though he was later lost to follow-up.<br /><br />The authors emphasize that reactive arthritis should remain high on the differential in HIV/AIDS patients with unexplained arthritis, and that careful sexual history, joint examination, and STI testing are essential. They also note that delays in diagnosis and treatment can lead to chronic, destructive joint disease.

Asset Subtitle

Keanu Chee

Meta Tag

Author List Anna M. Munoa, August Longino, Keanu Chee, Nathan Rockey

Category Clinical Vignettes

Concept HIV-Associated Arthropathy

Concept Reactive Arthritis

Concept Extra-articular Manifestation

Concept Diagnostic Workup

Concept Inflammatory joint symptoms

Distinguished Non-Finalist

Presenter Organization University of Colorado School of Medicine

Presenting Author Keanu Chee

Track Adult

Keywords

HIV infection

reactive arthritis

Chlamydia

conjunctivitis

asymmetric arthritis

diarrhea

sacroiliac joint

CD4 count

antiretroviral therapy

doxycycline

HIV-Associated Arthropathy

Reactive Arthritis

Extra-articular Manifestation

Diagnostic Workup

Inflammatory joint symptoms