RESUMO
A case of reactive arthritis in a patient with a previously documented history of Reiter's syndrome is described. The precipitating agent appears to have been Clostridium difficile. High levels of toxin were demonstrable in the faeces and neutralising antitoxin was detected in the patient's serum but not synovial fluid. Resolution of the polyarthropathy was slow despite successful eradication of the C. difficile with a course of vancomycin.
Assuntos
Artrite Infecciosa/etiologia , Infecções por Clostridium/complicações , Adulto , Artrite Reativa/complicações , Clostridium/isolamento & purificação , Fezes/microbiologia , Feminino , Humanos , Proctocolite/etiologiaRESUMO
A crystallizing IgG-lambda cryoprotein was found in the synovial fluid of a patient with peripheral erosive arthritis and tenosynovitis. The same crystallizing paraprotein could be demonstrated in serum incubated at 4 degrees C, but its formation could be inhibited by the in vitro addition of D-penicillamine. Crystals were present in synovial tissue and appeared to be initiating an inflammatory reaction via complement activation. Slit lamp examination showed crystals in Bowman's membrane. Plasmapheresis led to temporary improvement in the synovitis and tenosynovitis.