J Clin Neurol.  2007 Dec;3(4):215-218. 10.3988/jcn.2007.3.4.215.

A Case Report of Reiter's Syndrome with Progressive Myelopathy

• Kim SK
• An JY
• Park MS
• Kim BJ

• KMID: 1808563
• DOI: http://doi.org/10.3988/jcn.2007.3.4.215

Abstract

Reiter's syndrome belongs to the family of spondyloarthropathies that usually present with a triad of arthritis, urethritis, and uveitis. The diagnostic criteria include clinical, radiological, and genetic findings, and the response to treatment. Nervous system involvement in Reiter's syndrome is extremely rare. We report here on a 36-year-old man who initially presented with progressive cervical myelopathy and was diagnosed as Reiter's syndrome 2 years later. The myelopathy was stable after treatment with methotrexate and sulfasalazine. This case suggests that Reiter's syndrome can present as progressive myelopathy and should be considered in the differential diagnosis of treatable myelopathies.

Keyword

Myelopathy; Reactive arthritis; HLA-B27

MeSH Terms

Adult
Arthritis
Arthritis, Reactive
Diagnosis, Differential
HLA-B27 Antigen
Humans
Methotrexate
Nervous System
Spinal Cord Diseases*
Spondylarthropathies
Sulfasalazine
Urethritis
Uveitis
HLA-B27 Antigen
Methotrexate
Sulfasalazine

Figure

• 

  Figure 1 (A) T2-weighted sagittal and axial spine MRI demonstrated an area of high signal intensity in the spinal cord at the level of C7 and Th1, and mild swelling of the cord (arrow). The lesion exhibited a slightly low signal intensity on precontrast T1-weighted imaging and no enhancement after contrast administration (arrow in right image). (B) Follow-up T2-weighted sagittal spine MRI after the first steroid pulse therapy revealed a new linear lesion with a high signal intensity in the posterior portion of the spinal cord at the level of C7 to Th1 (arrow).

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  Figure 2 99mTc methylene diphosphonate whole-body bone scan showed active lesions in the left costomanubrial junction and first rib (arrow) (A). Pelvis anteroposterior radiograph demonstrated symmetrical joint space obliteration in the upper two-thirds of both sacroiliac joints (arrow) (B).

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  Figure 3 Swollen costochondral joint (arrow) and multiple pustular skin eruptionson the neck and trunk. The rash appeared as crops of clear, deep-seated, tapioca-like vesicles, and was very itchy. Results of a skin puncture biopsy were consistent with dyshidrotic dermatitis.

Reference

1. Montanaro A, Bennett RM. Myelopathy in Reiter's disease. J Rheumatol. 1984. 11:540–541.

2. Kim TH, Uhm WS, Inman RD. Pathogenesis of ankylosing spondylitis and reactive arthritis. Curr Opin Rheumatol. 2005. 17:400–405.

3. Hermann E, Yu DT, Meyer zum Buschenfelde KH, Fleischer B. HLA-B27-restricted CD8 T cells derived from synovial fluids of patients with reactive arthritis and ankylosing spondylitis. Lancet. 1993. 342:646–650.

4. Colmegna I, Espinoza LR. Recent advances in reactive arthritis. Curr Rheumatol Rep. 2005. 7:201–207.

5. Khan MA. Update on spondyloarthropathies. Ann Intern Med. 2002. 136:896–907.

6. Unverferth DV, Beman FM, Ryan JM, Whisler RL. Reiter's aortitis with pericardial fluid, heart block and neurologic manifestations. J Rheumatol. 1979. 6:232–236.

7. Cuchacovich M, Gatica H, Contreras L. Neurologic involvement in Reiter's disease. Report of 2 cases. Rev Med Chil. 1991. 119:687–690.

8. Fendler C, Laitko S, Sorensen H, Gripenberg-Lerche C, Groh A, Uksila J, et al. Frequency of triggering bacteria in patients with reactive arthritis and undifferentiated oligoarthritis and the relative importance of the tests used for diagnosis. Ann Rheum Dis. 2001. 60:337–343.

9. Palazzi C, Olivieri I, D'Amico E, Pennese E, Petricca A. Management of reactive arthritis. Expert Opin Pharmacother. 2004. 5:61–70.