Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient

Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

Artritis reactiva post-estreptocócica. Una revisión de literatura / Post-streptococcal reactive arthritis. A literature review

Introducción: existe un debate en la actualidad acerca de si la artritis reactiva post-estreptocócica es una entidad separada o una condición en el espectro de la fiebre reumática aguda. Objetivo: revisar la literatura existente sobre el tema artritis reactiva post-estreptocócica. Desarrollo : se realizó una búsqueda bibliográfica en Medline, Pubmed, Scielo y Dialnet, buscando como palabras clave: artritis y artritis reactiva post-estreptocócica. Además de la búsqueda computadorizada se realizó una búsqueda manual. Dichas bases de datos recogen las publicaciones más importantes en el campo científico de la medicina. La búsqueda se realizó en abril del 2018, y comprendió desde el año 1989 hasta la actualidad. Utilizamos el programa Reference Manager, versión 12, para crear una base de datos con las publicaciones, categorizarlas y filtrarlas de acuerdo a su relevancia para nuestro estudio. Se recabaron un total de 45 documentos en total, de los cuales fueron descartados unos 30, debido a su nivel de generalización y escasa especificidad en el tema abordado. Conclusiones: los signos clásicos de tumefacción, eritema, calor y dolor están presentes, siendo el dolor el más importante, está presente en reposo y aumenta con los movimientos. Como en la FR, la artritis postestreptocócica es una artritis reactiva caracterizada por una infección faríngeaestreptocócica, un intervalo libre y una posterior inflamación aséptica en una o más articulaciones(AU)

Introduction: there is currently debate about whether post-streptococcal reactive arthritis is a separate entity or condition in the spectrum of acute rheumatic fever. Objective: to review the existing literature on the topic post-streptococcal reactive arthritis. Development: a bibliographic search was carried out in Medline, Pubmed, Scielo and Dialnet, searching as keywords: arthritis and post-streptococcal reactive arthritis. In addition to the computerized search, a manual search was carried out. These databases collect the most important publications in the scientific field of medicine. The search was conducted in April 2018, and ran from 1989 to the present. We use the Reference Manager program, version 12, to create a database with publications, categorize them and filter them according to their relevance to our study. A total of 45 documents were collected, of which about 30 were discarded, due to their level of generalization and lack of specificity in the topic addressed. Conclusions: the classic signs of swelling, erythema, heat and pain are present, with pain being the most important, it is present at rest and increases with movements. As in RF, post-streptococcal arthritis is a reactive arthritis characterized by a pharyngeal-streptococcal infection, a free interval and subsequent aseptic inflammation in one or more joints(AU)

Severe Keratoderma Blenorrhagicum simulating Psoriasis in reactive Arthritis: A case report

Introduction@#Severe keratoderma blenorrhagicum (KB) is a rare cutaneous manifestation of reactive arthritis (ReA) which can be indistinguishable from psoriasis, making the diagnosis challenging. This is a case of reactive arthritis in a 33-year-old female presenting with disabling, painful oligoarthritis which was accompanied by generalized pustular and scaly rashes simulating psoriasis.@*Case@#A 33-year-old female, Filipino, single with no known co-morbidities presented with disabling, painful oligoarthritis which was accompanied by generalized pustular and scaly rashes of two weeks duration. Her symptoms were preceded a few days earlier with a transient episode of conjunctivitis. She also reported having recently received treatment for “urinary tract infection”. There were generalized hyperkeratotic papules with areas of desquamation overlying erythematous skin involving the scalp, hairline, trunk, and extremities including palms and soles, with onycholysis on all digits. The right wrist and both ankles were warm, swollen and tender, with dactylitis involving most toes. Dermatology consult concurred with the diagnosis of keratoderma blenorrhagicum associated with reactive arthritis, over psoriasis or psoriatic arthritis, and she was started on prednisone 60 mg/day; methotrexate (MTX) 20 mg/week and folic acid were added a week later. With dramatic resolution of both skin and joint involvement, prednisone was tapered to 10 mg/day over the next three weeks and MTX was maintained at 15 mg/week, with no rebound nor recurrence of symptoms.@*Conclusion@#Severe KB is a rare cutaneous manifestation of ReA which can be indistinguishable from psoriasis. The acute onset of symptoms, recent history of eye inflammation and genitourinary tract infection strongly favored ReA over psoriasis. A further hallmark of KB is the presence of sterile pustules on the palms and soles. Histologically, KB has more numerous pustules and massive hyperkeratosis compared to psoriasis. Moreover, the dramatic response to systemic steroids, without rebound nor recurrence upon steroid taper or discontinuation favors KB over psoriasis.

Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis

BACKGROUND: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis. METHODS: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations. RESULTS: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m2. These patients underwent 14 reverse shoulder arthroplasties (RSAs; 11 after antibiotic spacer placement), one anatomic total shoulder arthroplasty after antibiotic spacer placement, and two hemiarthroplasties (both after antibiotic spacer placement). Two patients underwent reoperation (dislocated RSAs). There were four complications (23.5%): two RSA dislocations, one acromial stress fracture, and one atraumatic rotator cuff tear after hemiarthroplasty. There were no cases of postoperative wound complications or infection. At an average of 4.1 ± 1.8 years of follow-up for all 17 of 17 cases, the average visual analogue scale pain score was 4.6 ± 2.3, average Single Assessment Numeric Evaluation Score was 59.3 ± 23.7, average American Shoulder and Elbow Surgeons Score was 57.6 ± 15.5, and average Simple Shoulder Test was 6.9 ± 2.6 based on “yes” responses. CONCLUSIONS: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates but no reinfection.

Diagnosis and Treatment of Inflammatory Joint Disease / 대한고관절학회지

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

Acute myopericarditis as primary manifestation of urogenital reactive arthritis by Staphylococcus haemolyticus metilcilino resistant / Miopericarditis aguda como manifestación primaria de artritis reactiva urogenital por Staphylococcus haemolyticus resistente a meticilina

Reactive arthritis describes the relationship between the host and the environment. This leads to urogenital or gastrointestinal infections. It clinically presents with inflammatory lumbosacral pain, asymmetric oligoarthritis and enthesitis of the Achilles tendon and plantar fascia. Among the extra-articular manifestations are acute anterior uveitis, skin lesions, genital lesions, and oral ulcers, with the rarest being cardiovascular. A case is presented of a patient with a urogenital infection and cardiovascular manifestations, interpreted and managed as acute coronary syndrome. After further studies an acute myopericarditis was considered as a primary manifestation of reactive arthritis.

La artritis reactiva describe la interrelación entre el hospedero y el medio ambiente. Aparece después de infecciones urogenitales o digestivas. Clínicamente presenta dolor lumbosacro inflamatorio, oligoartritis asimétrica y entesitis del tendón de Aquiles y la fascia plantar. Entre las manifestaciones extraarticulares, se encuentran la uveítis anterior aguda, lesiones en piel, lesiones genitales y úlceras orales. Las más infrecuentes son las cardiovasculares. Describimos el caso de un paciente con infección urogenital y manifestaciones cardiovasculares interpretadas y manejadas como síndrome coronario agudo, pero que a la luz de estudios posteriores se consideró finalmente una miopericarditis aguda como manifestación primaria de una artritis reactiva.

Autoimmune central diabetes insipidus in a patient with ureaplasma urealyticum infection and review on new triggers of immune response

Diabetes insipidus is a disease in which large volumes of dilute urine (polyuria) are excreted due to vasopressin (AVP) deficiency [central diabetes insipidus (CDI)] or to AVP resistance (nephrogenic diabetes insipidus). In the majority of patients, the occurrence of CDI is related to the destruction or degeneration of neurons of the hypothalamic supraoptic and paraventricular nuclei. The most common and well recognized causes include local inflammatory or autoimmune diseases, vascular disorders, Langerhans cell histiocytosis (LCH), sarcoidosis, tumors such as germinoma/craniopharyngioma or metastases, traumatic brain injuries, intracranial surgery, and midline cerebral and cranial malformations. Here we have the opportunity to describe an unusual case of female patient who developed autoimmune CDI following ureaplasma urealyticum infection and to review the literature on this uncommon feature. Moreover, we also discussed the potential mechanisms by which ureaplasma urealyticum might favor the development of autoimmune CDI.

Mercury Exposure in a Riverside Amazon Population, Brazil: A Study of the Ototoxicity of Methylmercury

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic. Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE). Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels. Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair. Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury. .

Syphilis associated with paretic neurosyphilis mimicking Reiter’s syndrome in HIV-infected patients

HIV/syphilis co-infection is common because both conditions affect similar risk groups. HIV interferes with the natural history of syphilis, which often has atypical clinical features and nervous system involvement in the early stage of disease. We report the case of an HIV-positive patient with secondary syphilis, scaling palmoplantar keratoderma, scrotal eczema, balanitis and urethritis mimicking Reiter’s syndrome. Immunohistochemistry using polyclonal antibodies against Treponema pallidum revealed the presence of spirochetes, associated with the paretic form of parenchymal neurosyphilis. The patient was given crystalline penicillin, with complete resolution of dermatological and neurological symptoms, and no sequelae.

Oligoartritis aguda tras tratamiento con BCG en paciente con neoplasia devejiga: reporte de caso / Acute oligoarthritis following BCG treatment for urinary bladder cancer: A case report

La instalación del bacilo de Calmette-Guérin es un tratamiento seguro y eficaz para elcáncer superficial de vejiga. La aparición de artritis tras su administración es un raro efectosecundario.Presentamos el caso clínico de un varón de 65 anos ˜ que desarrolló oligoartritis asimétricadespués de la sexta instalación del bacilo de Calmette-Guérin, que fue resuelta tras el cesedel tratamiento y la administración de antiinflamatorios no esteroideos...

Espondiloartropatía entérica: presentación de un caso / Enteric spondyloarthropathy: a case presentation

Seronegative arthropathies or spondyloarthropathy belong to a group of diseases that share clinical and genetic characteristics associated strongly with major histocompatibility complex class I HLA-B27. We report a case of a female patient of 39 years old with nightly back pain, morning stiffness and diffuse lumbar pain in the right buttock. In the immunological study observed negative rheumatoid factor and radiographic study observed right sacroiliitis. The final diagnosis is an enteric spondyloarthropathy...

Las artropatías seronegativas o espondiloartropatías corresponden a un grupo de enfermedades que comparten características clínicas y genéticas, asociadas fuertemente con el complejo mayor de histocompatibilidad clase I HLA-B27. Se presenta el caso de una paciente de 39 años con dolor lumbar nocturno, rigidez matutina lumbar y dolor difuso en la región glútea derecha.En el estudio inmunológico se observa factor reumatoídeo negativo, y al estudio radiológico se constata sacroileítis derecha. El diagnóstico final es una espondiloartropatía entérica...

Reactive Arthritis in a Patient with Chlamydia trachomatis Infection / 대한정형외과학회잡지

The authors report a case of reactive arthritis that was caused by sexual contact as below example. A 36-year-old male visited our center due to sudden pain in wrist joint, the 3rd finger, knee joint, and achilles tendon. There were no specific abnormalities for the immunoserologic tests and magnetic resonance imaging; however, we found a positive test result for the polymerase chain reaction test of urine that identified Chlamydia trachomatis. Through considering the patient's medical history and various examinations, we considered the possibility of reactive arthritis, to the exclusion of alternate diagnosis. According to the our diagnosis, the patient was treated with antibiotics and nonsteroidal anti-inflammatory drugs and we found that the patient was getting better. Therefore the authors think that we have to contemplate the possibility of reactive arthritis and treat appropriately in patients with similar symptoms.

Reactive arthritis in tuberculosis: A case of Poncet’s disease

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet’s disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet’s disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.

Reactive arthritis induced by bacterial vaginosis: prevention with an effective treatment

We report a 42-year-old woman with reactive arthritis induced by bacterial vaginosis who presented with oligoarthritis with an additive form, arthralgia, and enthesitis. She hasn't had a history of diarrhea or dysuria or vaginal secretion, or sexually transmitted infections [STIs]. The laboratory tests were normal except for a high erythrocyte sedimentation rate [ESR]. Her pelvic examination revealed homogeneous white grey and malodorous vaginal discharge on the vaginal wall and Pap smear and Gram-stained smear of vaginal swab was consistent with bacterial vaginosis. She responded to metronidazole therapy and her six-month follow up hasn't shown recurrence of arthritis. As reactive arthritis [ReA] is a paradigm of a rheumatic disease in which the initiating infectious cause is known, so early use of antimicrobial drugs may prevent the development of musculoskeletal symptoms which are triggered by infections

Reactive Arthritis / 대한내과학회지

Reactive arthritis (ReA) is an inflammatory joint disease following genitourinary or gastrointestinal bacterial infection, most commonly by Chlamydia trachomatis. It is characterized by the inflammation in the large joints of lower extremities such as ankles and knees and sometimes accompanied by enthesitis (Achilles tendinitis, plantar fasciitis) and sacroiliitis, which made it classified as spondyloarthritis. Although there are various theories about the role of persistent bacterial infection, toll-like receptor, and human leukocyte antigen-B27 in the pathogenesis of ReA, many things are still unknown. Clinical studies about the ReA have not been done well due to the absence of widely recognized diagnostic criteria. Although the evidence of prior infection is necessary for the diagnosis, it is not uncommon that preceding infection is asymptomatic, which make it difficult to diagnose ReA. Therefore, it is necessary to consider ReA in patients suffering from inflammation in the joints of lower extremities with unknown cause. Nonsteroidal anti-inflammatory drugs, corticosteroid, and sulfasalazine have been used in the treatment of ReA but antibiotics don't seem to work. Regarding the therapeutic role of anti-tumor necrosis factor agents, there are some controversies.

Artritis reactiva secundaria a fiebre por mordedura de rata: reporte de un caso clínico / Reactive arthritis secondary to rat-bite fever: report on a clinical case

Caso clínico: Paciente de sexo masculino, de 69 años, sin otros antecedentes. Debuta con dolor en zona de la cadera derecha transitorio, evolucionando con cuadro de seis días de desarrollo de fiebre hasta 39,2ºC, calofríos, artralgias en tarso derecho, rodillas, hombros y astenia, por lo que fue hospitalizado. Al examen destacaba aumento de volumen doloroso en rodilla izquierda y hombro derecho. El estudio de líquido articular descartó artritis infecciosa y presencia de cristales intraarticulares. Los exámenes séricos mostraban parámetros inflamatorios alterados con leucocitosis, VHS y PCR elevados. Panel viral negativo. Sin otro foco inflamatorio evidente, se inició manejo antibiótico empírico con Ceftriaxona y Cloxacilina, con buena respuesta, mejorando su sintomatología y parámetros inflamatorios. Cultivos articulares negativos. El Gram de hemocultivos demostró la presencia de bacilos Gram negativos, aislando en los hemocultivos Streptobacillus moniliformis. El paciente evoluciona favorablemente, con regresión total de su cuadro articular. Discusión y conclusión: La Fiebre por Mordedura de Rata es una enfermedad sistémica que típicamente se presenta con fiebre, rash cutáneo y poliartralgias migratorias. Uno de sus principales agentes causales es el Streptobacillus moniliformis, que coloniza la nasofaringe de ratas y otros roedores. Casos aislados han sido reportados en Chile. En la Fiebre por Mordedura de Rata hasta un 50 por ciento de los pacientes desarrolla artritis con derrame articular o sin él. Puede afectar cualquier articulación, pero la más comúnmente comprometida es la rodilla. El dolor articular disminuye en las primeras tres semanas del uso de antibióticos, pero la articulación en ocasiones puede llegar a ser destruida. En sujetos sanos se han reportado tasas de mortalidad de 10 por ciento a 15 por ciento. Mientras todos los síntomas se resuelven puede haber recaídas con graves complicaciones, como meningitis, endocarditis...

Clinical case: Male patient, 69 years old and no previous record. First episode with transitory pain in the right hip zone, going on to 6 days of fever that evolves to 39.2 ºC, shivers, articular pain in the right tarsus, knees, shoulders and asthenia, so he was hospitalized. Upon examination, painful swellings of the left knee and right shoulder stood out. A study of synovial fluid ruled out infectious arthritis and presence of intra-articular crystals. Blood tests showed altered inflammatory parameters with high leukocytes, VHS and CRP. Negative viral panel. Without another evident inflammatory focus, an empirical management was initiated by means of antibiotics with Ceftriaxone y Cloxaciline, which had a good response relieving symptoms and inflammatory panels. Negative articular culturing. The blood culture Gram showed presence of negative Gram bacilli, with the isolation of Streptobacillus moniliformis in the blood cultures. Patient evolves favorably, with full regression of his articular symptoms. Discussion and conclusion: Rat-bite fever is a systemic sickness that typically presents itself with high fever, skin rash and migratory poly-articular pain. One of its main causing agents is the Streptobacillus moniliformis that colonize the nasopharynx of rats and other rodents. Isolated cases have been reported in Chile. In Rat-bite Fever up to 50 percent of patients develop arthritis with and without joint effusion. It may affect any joint, but that most commonly compromised is the knee. Articular pain subsides in the first 3 weeks of use of antibiotics, but the joint may sometimes even be destroyed. Mortality rates in healthy individuals have been reported at 10 percent to 15 percent. While all symptoms disappear there might be relapses with serious complications such as meningitis, endocarditis, myocarditis, pneumonia and fulminant sepsis that may cause the patient to die. Timely diagnose and treatment are paramount to avoid its serious...

Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter syndrome / 中华创伤杂志(英文版)

Reactive arthritis or Reiter's syndrome characteristically affects the joint of the lower limb in an asymmetrical pattern. Usually it does not affect the axial skeleton or upper limbs. Although cases of atraumatic atlantoaxial subluxations have been reported, no case of spontaneous sternoclavicular dislocation in Reiter's syndrome has been reported. This paper describes a case of a 26 year old male patient who developed a spontaneous posterior sternoclavicular joint dislocation. No attempt of reduction was made and the patient was managed conservatively with good results.

Artrite de Poncet: relato de caso / Poncet's arthritis: case report

A doença de Poncet é uma condição clínica rara, caracterizada por um acometimento poliarticular em um paciente com diagnóstico de tuberculose, sem evidência de invasão direta do bacilo nas articulações, configurando uma artrite reativa. Documentamos um caso em Porto Alegre: um homem de 56 anos, com evidência de poliartrite aditiva de grandes articulações, investigada há 5 anos, sem diagnóstico definido. Ele havia sido submetido a uma nefrectomia unilateral há 5 anos, e o exame anatomopatológico do órgão revelou tuberculose renal. O teste tuberculínico atual revelou um forte reator (PPD = 20 mm). Análise do líquido sinovial não demonstrou invasão direta do bacilo. Foi instituído tratamento empírico com tuberculostáticos com remissão clínica após 2 meses. Embasados nesses dados, foi feito diagnóstico de doença de Poncet.

Poncet's disease is a rare clinical condition, characterized by polyarticular impairment in a patient diagnosed with tuberculosis, with no evidence of direct bacillary invasion of the joints, constituting reactive arthritis. We report a case of a 56-year old, white male from the city of Porto Alegre, with evidence of additive polyarthritis of the large joints, investigated for five years, and with no defined diagnosis. The patient had undergone unilateral nephrectomy five years before, and the anatomicopathological exam of the specimen revealed renal tuberculosis. The current tuberculin test was strongly reactive (PPD = 20 mm). Analysis of the synovial fluid showed no direct bacillary invasion. Tuberculostatic treatment was initiated and clinical remission occurred after two months. The diagnosis of Poncet's arthritis was established.

Enthesitis in a Patient with Systemic Lupus Erythematosus: The First Case Report / 대한내과학회지

We present the first case of enthesitis in the lumbar spine in a woman with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Enthesopathy is defined as pathological alterations at the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. In particular, enthesitis is the universal hallmark of seronegative spondyloarthropathies (SpA), including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and spondyloarthropathies associated with inflammatory bowel diseases. A 36-year-old female SLE patient with a history of lupus nephritis and thrombosis from APS presented with low back pain that had been gradually worsening for several months. She reported no previous episodes of trauma. Plain radiography indicated sclerosis at the anterior superior bodies of L3 and L5. Magnetic resonance imaging (MRI) showed low-intensity lesions on T1-weighted images and high-intensity lesions on T2-weighted images at the anterior superior bodies of L3, L4, and L5, consistent with osteitis or enthesitis. A nonsteroidal antiinflammatory drug (NSAID) was used as the first-line therapy in this patient, which improved her symptoms. This is the first report of enthesitis in the context of SLE. Although the possibility of coincidental occurrence of SpA and SLE cannot be excluded, the observations in this case suggest that enthesitis may be one of the manifestations of SLE.