Reactive Arthritis Induced by Bacterial Vaginosis: Prevention with an Effective Treatment
A 42-year-old woman presented with a history of pain and swelling of her several joints. At first, she complained of tenderness and pain and warm swelling of her right ankle and after two days she also had a similar problem in her left ankle. Her ankle swelling was reduced by ibuprofen. After that, she had arthralgia in the knees and her right elbow and then swelling of the metarsal joints have developed within two weeks. She claimed that resting and ibuprofen could reduce, but not cure her swelling and pain. She hasn’t had a history of diarrhea or dysuria or vaginal secretion, or sexually transmitted infections (STIs). She has been married and living with her husband. On physical examination, she had difficulty walking due to heel pain, a fever (38.8 C), swelling of her right ankle and right metatarsophalangeal joints. She had tenderness on both of achilles tendons attachments, the base of her right fifth metacarpal, and both patellar tendon insertions. There was no rash or vision problem. Laboratory data were normal for hemoglobin, leukocytes, erythrocyte, serum electrolytes, chemistry studies, and urine analysis except for erythrocyte sedimentation rate (ESR) which was 42 and C-reactive protein (CRP) was slightly elevated. Tests for human immunodeficiency virus (HIV) antibody, hepatitis B and C, brucellosis antibody, Chlamydia trachomatis antibody, cold agglutination test, rheumatic factor, lupus erythematosus (LE) cells, Antinuclear antibody (ANA) and Anti double stranded (ds) DNA were negative. She was advised to continue taking ibuprofen. Therapy with non-steroidal anti-inflammatory drugs wasn’t effective completely. These tests were repeated after four weeks and no new change has been observed. Her joints problem lasted more than three months. Her pelvic examination revealed homogeneous white grey and malodorous vaginal discharge on the vaginal wall. Her Pap smear and Gram-stained smear of vaginal swab showed benign cellular changes, predominance of Gram-variable coccobacilli consistent with shift in vaginal flora, mild inflammation. Treatment with metronidazole resulted in resolution of the symptoms.