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BMJ Case Reports 2016; doi:10.1136/bcr-2016-215552
  • CASE REPORT

Post-streptococcal reactive arthritis: where are we now

Open Access
  1. Tarnya Marshall
  1. Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Dr Himanshu Pathak, himanshu.pathak{at}nnuh.nhs.uk, hlpathak3{at}live.com
  • Accepted 2 July 2016
  • Published 12 August 2016

Summary

A 35-year-old man presented with polyarthritis and constitutional symptoms, and a recent history of multiple tick bites and skin rash on trekking holiday. He did not respond to oral doxycycline and cephalexine for presumed Lyme's disease. Further investigation confirmed strongly positive streptococcal serology. There was absence of clinical or echocardiography evidence of heart involvement and immunological screening for inflammatory arthritis was negative. In the absence of other major Jones criteria for acute rheumatic fever, besides polyarthritis and the serological evidence of a recent streptococcal infection, a diagnosis of post-streptococcal reactive arthritis (PSRA) was also made. He responded well to penicillin therapy and has been started on oral penicillin prophylaxis as per available guidance. As streptococcal infections in the adult population are increasingly reported, it is a timely opportunity to revisit PSRA, and develop comprehensive treatment and antibiotic prophylaxis guidelines.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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