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

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.