title: Clostridium difficile associated reactive arthritis: Case report and literature review.
abstract: BACKGROUND
  Extra-gastro-intestinal tract manifestations associated with Clostridium difficile infection (CDI), including reactive arthritis (ReA), are uncommon.
  
  
  METHODS
  We report a case of ReA associated with a relapse of CDI in a 46-year-old woman. A toxigenic C. difficile strain was isolated from stools and characterized as PCR-ribotype 014/020/077. We conducted a comprehensive literature review of ReA associated with CDI (ReA-CDI). Diagnostic criteria for ReA-CDI were: (i) evidence of aseptic synovitis (confirmed by culture) developing during or immediately after colitis, (ii) presence of a toxigenic C. difficile strain in stool samples, and (iii) absence of other causes of colitis and arthritis.
  
  
  RESULTS
  Forty-nine cases of ReA-CDI (excluding the present report) have already been described since 1976. Of these reports, Mean age of patients was 38 years (SD: 18.5), 46% were male, and 68% had HLA B27 genotype. Sixty-nine percent of patients received a β-lactamin treatment before CDI. ReA-CDI occurred a median 10 days (range 0-55 days) after CDI. Outcome was favorable in 90% of patients and oral non anti-inflammatory drugs were required for 55%.
  
  
  CONCLUSIONS
  ReA-CDI remains uncommon. Compared to the general population, it is more likely observed in younger patients with HLA B27-positive genotype.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Legendre
authors.affiliation: Laboratoire de Microbiologie, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Lalande
authors.affiliation: Laboratoire Clostridium difficile associé au Centre National de Référence des Bactéries Anaérobies, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Eckert
authors.affiliation: Laboratoire de Microbiologie, APHP, Hôpital Saint-Antoine, Paris, France; Laboratoire Clostridium difficile associé au Centre National de Référence des Bactéries Anaérobies, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Barbut
authors.affiliation: Service de Médecine Interne, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Fardet
authors.affiliation: Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Saint-Antoine, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Meynard
authors.affiliation: Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Saint-Antoine, Paris, France; Sorbonne University, UPMC University Paris 06 CR7, Paris, INSERM U1135, CIMI, Team E13, France. Electronic address: laure.surgers@aphp.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Surgers
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015415:Biomarkers; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D018836:Inflammation Mediators; D008875:Middle Aged; D000091402:Prohibitins; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D018836:Inflammation Mediators; C000717331:PHB2 protein, human; D000091402:Prohibitins
keywords: Clostridium difficile; Extra-digestive manifestations; HLA-B27; PCR-ribotype; Reactive arthritis