Skip to main content
SpringerLink
Log in

Clostridium difficile: an under-recognized cause of reactive arthritis?

  • Case Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Reactive arthritis usually presents as a sterile, inflammatory, asymmetric oligoarthritis, affecting large lower extremity joints. Extra-articular features (conjunctivitis, uveitis, enthesopathy, urethritis, balanitis, keratoderma blenorrhagicum) may occur. Common causes of enteric reactive arthritis are preceding infections attributable to Salmonella, Shigella, Campylobacter, and Yersinia. In contrast, Clostridium difficile is an uncommon cause of reactive arthritis, with only ∼40 reported cases. We describe a patient with an intense additive, asymmetric oligoarthritis after an antecedent C. difficile infection. The potential contribution of C. difficile to more insidious cases of undifferentiated oligoarthritis is discussed, with emphasis on corresponding therapeutic interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Flores D, Marquez J, Garza M, Espinoza LR (2003) Reactive arthritis: newer developments. Rheum Dis Clin North Am 29(1):37–59, vi. Feb

    Article  PubMed  Google Scholar 

  2. Hill Gaston JS, Lillicrap MS (2003) Arthritis associated with enteric infection. Best Pract Res Clin Rheumatol 17(2):219–239. Apr

    Article  PubMed  CAS  Google Scholar 

  3. McCluskey J, Riley TV, Owen ET, Langlands DR (1982) Reactive arthritis associated with Clostridium difficile. Aust N Z J Med 12(5):535–537. Oct

    PubMed  CAS  Google Scholar 

  4. Atkinson MH, McLeod BD (1988) Reactive arthritis associated with Clostridium difficile enteritis. J Rheumatol 15(3):520–522. Mar

    PubMed  CAS  Google Scholar 

  5. Hayward RS, Wensel RH, Kibsey P (1990) Relapsing Clostridium difficile colitis and Reiter's syndrome. Am J Gastroenterol 85(6):752–756. Jun

    PubMed  CAS  Google Scholar 

  6. Loffler HA, Pron B, Mouy R, Wulffraat NM, Prieur AM (2004) Clostridium difficile-associated reactive arthritis in two children. Joint Bone Spine 71(1):60–62. Jan

    Article  PubMed  Google Scholar 

  7. Jacobs A, Barnard K, Fishel R, Gradon JD (2001) Extracolonic manifestations of Clostridium difficile infections. Presentation of 2 cases and review of the literature. Medicine (Baltimore) 80(2):88–101. Mar

    Article  CAS  Google Scholar 

  8. (1998) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1998. A 70-year-old man with diarrhea, polyarthritis, and a history of Reiter’s syndrome. N Engl J Med 338(25):1830–1836. Jun 18

  9. Kocar IH, Caliskaner Z, Pay S, Turan M (1998) Clostridium difficile infection in patients with reactive arthritis of undetermined etiology. Scand J Rheumatol 27(5):357–362

    Article  PubMed  CAS  Google Scholar 

  10. Putterman C, Rubinow A (1993) Reactive arthritis associated with Clostridium difficile pseudomembranous colitis. Semin Arthritis Rheum 22(6):420–426. Jun

    Article  PubMed  CAS  Google Scholar 

  11. Goldman WM, Avicolli AS, Lutwick S (1994) Clostridium difficile colitis. N Engl J Med 330(24):1755. Jun 16

    PubMed  CAS  Google Scholar 

  12. Duchmann R, May E, Ackermann B, Goergen B, Meyer zum Buschenfelde KH, Marker-Hermann E (1996) HLA-B27-restricted cytotoxic T lymphocyte responses to arthritogenic enterobacteria or self-antigens are dominated by closely related TCRBV gene segments. A study in patients with reactive arthritis. Scand J Immunol 43(1):101–108. Jan

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA

    Julius Birnbaum, John G. Bartlett & Allan C. Gelber

Authors
  1. Julius Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John G. Bartlett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allan C. Gelber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan C. Gelber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Birnbaum, J., Bartlett, J.G. & Gelber, A.C. Clostridium difficile: an under-recognized cause of reactive arthritis?. Clin Rheumatol 27, 253–255 (2008). https://doi.org/10.1007/s10067-007-0710-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-007-0710-2

Keywords

Search

Navigation