Pediatr Allergy Respir Dis.  1999 Sep;9(3):320-326.

A Case of Salmonella-triggered Reactive Arthritis in a Child, Initially Presented as Juvenile Rheumatoid Arthritis

• Shin EW
• Chung DS
• Park SJ
• Yang S
• Kim YJ
• Lee HB

Abstract

Salmonella-triggered reactive arthritis appears one to three weeks after the onset of salmonella infection and presents with asymmetric, usually migratory, oligo- or polyarthritis. The course is usually self-limiting and symptoms last two to six months. We experienced a 10-year-old male patient who presented to a local pediatric center with long-lasting fever and right ankle joint pain. The pain migrated to the left ankle joint, both wrists, and both knees and he was diagnosed as juvenile rheumatoid arthritis and was medicated with NSAIDs and corticosteroid. In the meantime, 20 days prior to the transfer to our hospital he was febrile with nausea and abdominal pain and the antibody titer of S. typhi O Ag by Widal test was 1 : 320, and an antibiotic therapy was followed. Soon after, the fever subsided but the migrating joint symptoms continued and he was transferred to our hospital. Widal tests were weekly checked and the antibody titers of S. typhi O Ag were 1 : 160, 1 : 320, 1 : 320, 1 : 160, 1 : 160, respectively. ESR was 55 mm/hr, CRP 9.18 mg/dl, HLA-B27 positive and his endoscopic findings of the colon showed mild lymphoid hyperplasia and mucosal nodularities in the cecum and ileocecal area. Stool cultures and duodenal juice culture for Salmonella and Shigella were all negative. He was treated with ibuprofen and bactrim and the joint symptoms were gradually mitigated. After discharge, he maintained mildly elevated CRP levels and antibody levels by Widal tests, but was free from symptoms except for several episodes of finger pains for 11 months.

Keyword

Salmonella infection; Reactive arthritis

MeSH Terms

Abdominal Pain
Ankle Joint
Anti-Inflammatory Agents, Non-Steroidal
Arthritis
Arthritis, Juvenile*
Arthritis, Reactive*
Cecum
Child*
Colon
Fever
Fingers
HLA-B27 Antigen
Humans
Hyperplasia
Ibuprofen
Joints
Knee
Male
Nausea
Salmonella
Salmonella Infections
Shigella
Trimethoprim, Sulfamethoxazole Drug Combination
Wrist
Anti-Inflammatory Agents, Non-Steroidal
HLA-B27 Antigen
Ibuprofen