A fatal case of Reiter's disease complicated by amyloidosis

Abstract

The clinical course of an 18-year-old boy with Reiter's disease is described. Diarrhea occurred at times, as did occasional melena. Remission occurred after 6 months, but 3 months later, following a severe relapse involving the skin, the joints, and the bowel, paralytic ileus developed, and at laparotomy colectomy was performed. On the sixth postoperative day he died. The postmortem findings were of bronchopneumonia and widespread amyloidosis, including involvement of the bowel.Reiter's disease usually has a natural course, in the first attack, of 1 to 3 months, with a percentage of cases having recurrences in succeeding years. T h e prognosis is good for the overwhelming majority of patients (1). Death, when it has been reported in the early stages, has been due to massive gastric hemorrhage associated with gastric ulceration and necrosis of the submucosa (2,3) and in the late stages to aortic incompetence, heart block, and its complications (4). Only one report of amyloid complicating Reiter's disease and causing colitis and death has been found, and the case to be described has many features in common with it (5). CASE REPORT HistoryThe patient, an 18-year-old, single, European male was admitted to hospital in January 1967. H e had been well un- ti1 July 1966, when he had a bout of diarrhea lasting 2 months. During this time he had 6 loose bowel movements a day unassociated with the passage of blood and mucus. He received no treatment, the diarrhea ceased spontaneously, and he did not lose weight during this time.In October 1966, he became tired, anorexic, and listless. He developed lumbar back pain which necessitated leaving his occupation as a laborer for a logging firm to work as a salesman in a department store. In the second week of November his lower limbs became painful in both the muscles and joints (Figure 1). About this time he had sexual intercourse and a week later developed urethritis with a thick whitish discharge, dysuria, and midabdominal pain. He had last had sexual intercourse in March 1966.In early January 1967 he developed a painless bilateral conjunctivitis which was treated with penicillin. Both the conjunctivitis and urethritis settled within a few days.Seven days before admission a cow trod on his left instep. Two days later he developed arthritis of his left ankle. This was followed by rigors, sweating, and fever, and an exacerbation of his lumbosacral pain. The right ankle joint became hot, swollen, and tender, and he developed a pharyngitis; he was given penicillin, aspirin, and indomethacin. Two days after this he passed 5 to 10 black stools per day for 2 days. On the day before admission his knees became acutely tender and swollen, and it was for this reason he was admitted to hospital.H e had had no significant illnesses in the past. There was no family history of joint disease or psoriasis. Physical ExaminationThe patient was wasted, febrile (39' C), and had a polyarthritis involving the shoulders, elbows, wrists, metacarpophalangeal joints, hips, knees, ankles, and feet. There ...

Nail Changes as the First Manifestation of the HLA-B27 Inheritance

“…Amyloidosis in association with Reiter's disease is apparently rare, but it has been reported at least by C a u g h ey and W akem [7], HLA-B27 combined with HLA-A2 in both the father and the son fits well within the earlier observations. The lack of the antigens associated with psoriasis, HLA-B13 and B17 [19,23], shall be noticed in the differential diagnosis of the nail changes, although psoriasis cannot be ruled out on the basis of HLA typing.…”

Reiter's syndrome followingshigella flexneri 2a

“…Review of liver disease associated with RS discloses hepatitis (jaundice) (1,(23)(24)(25)(26), salicylate hepatotoxicity (27), and amyloidosis (28)(29)(30). In the present patient, if one assumes simultaneous infections by a hepatitis virus a n d Shigella flexneri, the incubation period for the hepatitis would be 40 days, within the range for type A.…”