Shigellu Jlexneri 2a was isolated from a patient with Reiter's syndrome (RS) following a family outbreak of traveler's diarrhea. Among 3 members at risk, only the patient was positive for HLA-B27. Data from 3 similar families support the hypothesis that susceptibility to R S is genetically transmitted. It is urged that every effort be made to culture and subtype Shigellu and other enteric pathogens in RS following diarrhea. Concurrently, the patient had hepatitis, interpreted as a parallel enteric infection.Clusters of Reiter's syndrome (RS) have occurred during land-based (1 ) and ship-board (2) epidemics of Shigellu dysentery and among recruits arriving in a zone where dysentery is prevalent (3). There are several accounts of 2 or more individuals within a household who developed features of RS following diarrhea (43). This is the fourth report of RS following family outbreaks of traveler's diarrhea acquired in Mexico (6-9), and the second such family with proved shigellosis. HLA typing showed the B27 antigen in the present patient with RS, but not in the 2 accompanying family members.Because the patient developed probable infective hepatitis during his illness, hepatic involvement in RS has also been reviewed.
CASE REPORTThe patient (11-3, Figure I), a 39-year-old executive of Norwegian ancestry, developed fever and persistent diarrhea 24 hours after eating a meal including raw oysters served on the first day of his arrival in Mexico in March 1973. He was accompanied by his wife (11-6) and son (111-I), age 1 I, who became ill at the same time with diarrhea and vomiting that lasted 24 hours without sequellae. On day 15 purulent conjunctivitis appeared, lasting 2 weeks. On day 16, the patient was seen at the University of Michigan Medical Center because of persistent diarrhea and fever up to 40°C. A stool specimen obtained at sigmoidoscopy contained giardia lamMia; bacterial culture was negative for pathogens. Metronidazole for 24 days, average 875 mg/d, resulted in the disappearance of the parasite, but diarrhea and fever persisted. On day 33. pain appeared in the low back, neck, and ribs, soon followed by pain and swelling of the ankles, knees, hands, and wrists. A repeat stool culture on day 33 was also negative, but a stool cultured on day 36 grew out S.flexneri 2a. O n day 40, scleral icterus and dark urine were noted, and bilirubinuria was demonstrated. During this period the aspirin intake was 3.3 g/d and serum salicylate was 16.8 mg/dl.On day 53, when the patient was transferred to the Ann Arbor Veterans Administration Hospital, physical examination showed a well-developed icteric man in moderate pain whose temeprature was 38.5"C. A tender liver, 10 cm in total height, and circinate balanitis were noted. There was tenderness over the spine, limitation of head turning and lumbar
