Clostridium difficile associated reactive arthritis: Case report and literature review

• Published in: Anaerobe 2016-04, Vol.38, p.76-80
• Main Authors: Legendre, Paul, Lalande, Valérie, Eckert, Catherine, Barbut, Fréderic, Fardet, Laurence, Meynard, Jean-Luc, Surgers, Laure
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Arthritis, Reactive - diagnosis; Arthritis, Reactive - drug therapy; Arthritis, Reactive - etiology; Biomarkers; Clostridium difficile; Clostridium difficile - classification; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Clostridium Infections - complications; Clostridium Infections - drug therapy; Clostridium Infections - microbiology; Extra-digestive manifestations; Feces - microbiology; Female; HLA-B27; Human health and pathology; Humans; Hépatology and Gastroenterology; Inflammation Mediators; Life Sciences; Middle Aged; PCR-ribotype; Reactive arthritis; Treatment Outcome
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2015.12.011

Extra-gastro-intestinal tract manifestations associated with Clostridium difficile infection (CDI), including reactive arthritis (ReA), are uncommon. We report a case of ReA associated with a relapse of CDI in a 46-year-old woman. A toxigenic C. difficile strain was isolated from stools and characterized as PCR-ribotype 014/020/077. We conducted a comprehensive literature review of ReA associated with CDI (ReA-CDI). Diagnostic criteria for ReA-CDI were: (i) evidence of aseptic synovitis (confirmed by culture) developing during or immediately after colitis, (ii) presence of a toxigenic C. difficile strain in stool samples, and (iii) absence of other causes of colitis and arthritis. Forty-nine cases of ReA-CDI (excluding the present report) have already been described since 1976. Of these reports, Mean age of patients was 38 years (SD: 18.5), 46% were male, and 68% had HLA B27 genotype. Sixty-nine percent of patients received a β-lactamin treatment before CDI. ReA-CDI occurred a median 10 days (range 0–55 days) after CDI. Outcome was favorable in 90% of patients and oral non anti-inflammatory drugs were required for 55%. ReA-CDI remains uncommon. Compared to the general population, it is more likely observed in younger patients with HLA B27-positive genotype. •Clostridium difficile associated reactive arthritis are uncommon.•It is more likely observed in younger patients with HLA B27-positive genotype.•Outcome was favorable in 90% of patients.