DrVirgo
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An 18 year odl man presents with pain in his left knee and right ankle. there is no history of trauma. The young man states that he has not felt well since recovering from a 2 week diarrheal illness 1 month ago. On physical exam, his temp is 100.6, BP is 100/70, pulse is 76. and rest are 16.
He has bilateral conjunctivitis. his right ankle and left knee are swollen, erythematous, warm and tender. There is a small effusion present in the knee. His right Achilles tendon is also erythematous and tender. Synovial fluid from his knee shows a white blood cell count of 10,000/mm3, with 80% neutrophils. No organisms are seen on Gram stain. Which of the following is the most likely diagnosis?
A. Chron's disease
B. Felty Syndrome
C. Gout
D. Juvenile RA
E. Reiter Syndrome
F. Septic Arthritis
E OR F???
Please explain your answer. thanks.
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| Justice
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E. Reiter Syndrome
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| khorshid
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E (two weeks after diarrhea, two joints involved, neg gram stain, conjunctivitis...no trauma...)
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| ssrpk
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gram stain has a low sensitivity and specificity , even culture has low sens/spec. therefore if and only IF infection is suspected then do we take multiple cultures....the most important clue here is not very much elevated wbc's...i would have gone for septic arthritis if the WBC count had been 50000 plus
answer is undoubtedly E
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| prathapdoctor
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I agree with SSRPK, WBC count is the clue.
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| DrVirgo
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Reiters syndrome is a reactive arthritis which consists of three things:
conjunctivitis, urethritis, and arthritis. (It occurs after an infection with nongonoccal urethritis with chlamydia or ureaplasma.)
But there is another form of Reactive Arthritis which occurs after an infectious diarrhea. (IS THIS FORM CONSIDERED TO BE REITERS SYNDROME AS WELL?)
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| prathapdoctor
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yes, the triad even after acute diarrheal also must be called as Reiters only.
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| DrVirgo
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OK. THANKS! 
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