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Clinical case
Reactive arthritis after COVID-19 infection
  1. Keisuke Ono1,
  2. Mitsumasa Kishimoto1,
  3. Teppei Shimasaki2,
  4. Hiroko Uchida1,
  5. Daisuke Kurai2,
  6. Gautam A Deshpande3,
  7. Yoshinori Komagata1 and
  8. Shinya Kaname1
  1. 1 Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Shinkawa, Mitaka-shi, Tokyo, Japan
  2. 2 Department of Infectious Disease, Kyorin University School of Medicine, Shinkawa, Mitaka-shi, Tokyo, Japan
  3. 3 Department of Internal Medicine, University of Hawaii at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
  1. Correspondence to Mitsumasa Kishimoto; kishimotomi{at}


Reactive arthritis (ReA) is typically preceded by sexually transmitted disease or gastrointestinal infection. An association has also been reported with bacterial and viral respiratory infections. Herein, we report the first case of ReA after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This male patient is in his 50s who was admitted with COVID-19 pneumonia. On the second day of admission, SARS-CoV-2 PCR was positive from nasopharyngeal swab specimen. Despite starting standard dose of favipiravir, his respiratory condition deteriorated during hospitalisation. On the fourth hospital day, he developed acute respiratory distress syndrome and was intubated. On day 11, he was successfully extubated, subsequently completing a 14-day course of favipiravir. On day 21, 1 day after starting physical therapy, he developed acute bilateral arthritis in his ankles, with mild enthesitis in his right Achilles tendon, without rash, conjunctivitis, or preceding diarrhoea or urethritis. Arthrocentesis of his left ankle revealed mild inflammatory fluid without monosodium urate or calcium pyrophosphate crystals. Culture of synovial fluid was negative. Plain X-rays of his ankles and feet showed no erosive changes or enthesophytes. Tests for syphilis, HIV, anti-streptolysin O (ASO), Mycoplasma, Chlamydia pneumoniae, antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide antibody and Human Leukocyte Antigen-B27 (HLA-B27) were negative. Gonococcal and Chlamydia trachomatis urine PCR were also negative. He was diagnosed with ReA. Nonsteroidal Anti-Inflammatory Drug (NSAID)s and intra-articular corticosteroid injection resulted in moderate improvement.

  • Arthritis
  • Reactive
  • Infectious

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  • KO, MK and TS contributed equally to this clinical case

  • Contributors All authors contributed drafting of this manuscript. KO, MK and TS contributed equally to this clinical case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Consent obtained directly from patient(s).

  • Ethics approval We have obtained consent from our patient.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the clinical case are included in the article.

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