Introduction Reiter's syndrome is a relatively rare, non-suppurative, sero-negative arthropathy seen among young adults with HLAB27. Epidemic (post-enteric) and endemic (sexually acquired) variants of the disease may occur. Reiter's disease is difficult to manage because of its chronic recurring course. The prevalence of Reiter's syndrome in HIV-infected patients varies between 1.7% and 11.2%. The course of the disease is more severe and progressive in these patients and often refractory to treatment. Here, clinical features and management of three HIV infected patients with Reiter's syndrome have been described.
Case reports Three heterosexual men, age ranging from 20 to 40 years presented with psoriasiform skin lesions, dystrophic nail changes and incapacitating arthritis involving bilateral knees, ankles and toes of 3–6 months duration. Two of the patients had asymptomatic balanitis. Skin lesions, keratoderma blenorrhagica, were generalised and severe in one patient and were restricted to extremities in two others. There was no history of preceding gastro-intestinal infection or urethritis in any of them. All the three patients had history of unprotected sex with commercial sex workers in the past. They were tested HIV positive (Western blot method) and CD4 T cell count was 550, 489 and 450 respectively. The patients were treated with a combination of indomethacin, sulfasalazine for the arthritis and systemic isotretinoin. Arthritis responded to sulfasalazine and indomethacin. Cutaneous and nail changes responded to systemic isotretinoin. Long term treatment was required for all patients and one had recurrent flare-up of symptoms.
Conclusion Reiter's syndrome is one of the causes of rheumatic disorders in HIV-infected patients. Direct etiological role of HIV infection in the development of Reiter's syndrome is not established. Reiter's syndrome as a manifestation of immune reconstitution syndrome in a HIV-infected patient has been reported. Clinical severity of the disease may be increased because of underlying immunosuppression. These patients present with therapeutic challenge because of the restricted opportunity to use conventional immunosuppressive therapeutic agents.
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