Clinical tetrad of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions (HLA-B27-associated spondyloarthropathy, Reiter syndrome): report of a case.

A 21-year-old male patient with the clinical tetrad of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions, commonly known as Reiter syndrome was presented. He was hospitalized in poor condition, with fever, bilateral conjunctivitis, swollen and painful knee and tarsal joints, low back pain, Achilles tendonitis, dactilitis, keratoderma blenorrhagica, purulent urethritis, circinate balanitis, and oral erosive lesions. Radiography and Computerized Axial Tomography (CAT) showed sacroileitis, spondilosis thoracalis, and arthritis of the feet. The laboratory studies revealed anemia, neutrophilic leukocytosis, elevated erythrocyte sedimentation rate (ESR), hypoalbuminemia, negative rheumatoid factor, pyuria, proteinuria, and the presence of HLA-B27. The microbiological examinations of samples from pustular lesions, throat, eyes, urethra, stool, and blood were sterile. Urethral smear was positive for Chlamydia trachomatis (PCR). The histopathological picture of skin lesions was consistent with pustular psoriasis. Systemic treatment with antibiotics, corticosteroids, and non-steroidal anti-inflammatory drugs produced clinical improvement. This clinical syndrome requires comprehensive evaluation and multidisciplinary management.

Chlamydia trachomatis infections in eastern Europe: legal aspects, epidemiology, diagnosis, and treatment.

OBJECTIVES: Knowledge concerning genital Chlamydia trachomatis infections in eastern Europe is scarce. Data on the legal aspects, epidemiology, diagnosis, and treatment of the infection have never been collected, summarised, and presented to the international scientific community. The aim of this study was to present the current situation on the main aspects of chlamydial infections in the countries of eastern Europe. METHODS: Written questionnaires concerning legal aspects, epidemiology, diagnosis, and treatment of the infection were distributed among national STI operating administrators as well as researchers who had presented papers at earlier meetings of European chlamydia or STI societies. RESULTS: Most of the countries have not legalised reporting of chlamydial infections and in those who have done so, the quality of the reporting system is poor. Contact tracing is mostly done on a voluntary basis. Reported chlamydia incidence varies from 21 to 276 per 100000 inhabitants. The most commonly used diagnostic test remains the direct immunofluorescence test; however, some tendencies towards nucleic acid amplification are in evidence. Diagnostic services are paid for by the patient himself, while treatment in many countries is partially or completely covered by public insurance. CONCLUSIONS: This is the first report summarising data concerning the situation on C trachomatis infections in eastern Europe. The reporting system and diagnosis of C trachomatis infections remain suboptimal, which allows neither control of the epidemiological situation nor optimal treatment of the patients. The most urgent work currently necessary is the education of professionals and the general population.