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HLA-B27 spondyloarthritis and spotted fever rickettsiosis: case-based review


Rickettsia rickettsii, a tick borne disease, is the pathogen responsible for inducing Rocky Mountain Spotted Fever (RMSF), an illness that can progress to fulminant multiorgan failure and death. We present a case where R. rickettsii, acquired on a camping trip, precipitated a flare of peripheral arthritis and episcleritis in an HLA-B27 positive patient. Although Yersinia, Salmonella, Mycobacteria, Chlamydia, Shigella, Campylobacter, and Brucella have been previously associated with HLA-B27 spondyloarthritis, this unusual case demonstrates that obligate intracellular rickettsial organisms, and specifically, R. rickettsii, can also induce flares of HLA-B27 spondyloarthritis. Rickettsial infections in general can rapidly become fatal in both healthy and immunosuppressed patients, and thus, prompt diagnosis and therapy are required.

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All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Drs. AHR, JRT, and WLS collected the data, figures, and wrote the first manuscript draft; Dr. ADB, MF, and NSE, and Ms. SS help to organize the study, perform, and confirm citation searches, and revised the manuscript and figures.

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Correspondence to Wilmer L. Sibbitt Jr..

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This was a case study exempted by the local Investigational Review Board (IRB). No animal studies were performed.

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The subject gave informed consent to participate prior to all interventions and specifically provided permission for publication of this de-identified data, case report, and manuscript. All studies were carried out in accordance with the World Medical Association Declaration of Helsinki (JBJS 79A:1089-98, 1997). Patient confidentiality was protected according to the U.S. Health Insurance Portability and Accountability Act (HIPAA) and all data have been de-identified.

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Redford, A.H., Trost, J.R., Sibbitt, W.L. et al. HLA-B27 spondyloarthritis and spotted fever rickettsiosis: case-based review. Rheumatol Int 39, 1643–1650 (2019).

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