A 23-year-old woman comes to the Rheumatology Clinic for review. She complains of lower back pain with stiffness, more marked in the morning, and pain in her wrists, fingers, ankles and the soles of her feet. She has returned a few days ago from a trekking holiday in India, during which she was admitted with a gastrointestinal illness and right iliac fossa pain. She recovered from that episode with intravenous (IV) fluids and IV gentamicin. Examination in the clinic reveals a rash on both shins consistent with erythema nodosum. You confirm some limitation of forward flexion of the spine and small joint arthropathy affecting the wrists, fingers and ankles. Bloods reveal an elevated C-reactive protein (CRP) level of 35 mg/l. Which one of the following options is the most likely cause of her abdominal pain while in India?
- Campylobacter jejuni
- Epstein–Barr virus infection
- Escherichia coli
- Salmonella Typhi
- Yersinia enterocolitica
0 voters
Explanation
Yersinia enterocolitica (YE) fits with the clinical picture here, an episode of pseudoappendicitis, which recovered over the course of a few days, followed by an episode of reactive arthritis with erythema nodosum. When antibiotic intervention is required for severe acute YE, aminoglycosides are the intervention of choice. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the initial intervention of choice for reactive arthritis.