Clinical Image: Keratitis in reactive arthritis

Abstract

ing spectrum of encephalitis with NMDA receptor antibodies in young children. J Child Neurol 2010;25:742-5. 14. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Clinical Image: Keratitis in reactive arthritisThe patient, a 24-year-old man, presented to the ophthalmology cornea clinic with a 10-day history of pain and severe photophobia in his left eye. Examination revealed bilateral anterior stromal keratitis with multiple subepithelial infiltrates and epithelial breakdown; infiltration and breakdown were more extensive in the left eye, as seen in this slit lamp photograph. There was relatively little conjunctival injection, and the best corrected visual acuity was slightly reduced in the left eye (at 20/25). He had been referred from the ophthalmology emergency department, where he had presented 7 days previously and had been treated empirically with topical chloramphenicol, which produced no improvement. Results of polymerase chain reaction analysis of a conjunctival swab obtained at that time were negative for herpes simplex virus. Two months earlier, he had had culture-proven Salmonella gastroenteritis, which had been followed 10 days later by conjunctivitis and polyarticular arthritis affecting the knees, ankles, and left elbow. At that time, his erythrocyte sedimentation rate was 84 mm/hour and antinuclear antibody, rheumatoid factor, and anti-citrullinated protein antibodies were absent. He was diagnosed as having salmonella-related reactive arthritis (ReA). At presentation to our clinic he was taking oral prednisolone (20 mg/day), as prescribed by his rheumatologist. ReA occurs in Յ4% of patients ϳ1 month after an occurrence of gastroenteritis caused by Shigella, Salmonella, or Campylobacter. While the triad of ReA includes conjunctivitis, numerous other ocular manifestations have been described, including episcleritis, scleritis, and uveitis. Keratitis is a rarely reported manifestation of ReA. In this case, treatment with prednisolone acetate 1% drops led to complete resolution of the ocular symptoms within days, and disappearance of the clinical signs within 3 weeks. After 1 year, the keratitis has not recurred. Niamh E. Collins, MRCSI(Ophth) Royal Victoria Eye and Ear Hospital

Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

“…Collins et al 4 treated a patient with an established history of reactive arthritis and bilateral anterior stromal keratitis involving the epithelial and subepithelial layers with topical prednisolone acetate, which resolved after 3 weeks. Similarly, Rowson and Dart5 described a case of bilateral anterior stromal keratitis with epithelial defect which improved within 1 month on topical prednisolone, without any residual scarring.…”

Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework

“…Infection of Shigella has been linked to reactive arthritis, previously known as Reiter’s syndrome, which is a rare presentation of infection-induced arthritis that can cause conjunctivitis, among other non-ocular symptoms ( 108 ). Non-typhoidal Salmonella species have also been implicated in reactive arthritis, causing keratitis, uveitis and conjunctivitis ( 109 , 110 ). While some strains of E.coli are known to impact the eye, the O157:H7 strain is not known to cause ocular disease.…”