Abstract
A 39-year-old Japanese man visited our hospital with serious atopic dermatitis. After several days, he was admitted due to fever, general fatigue, appetite loss, cervical pain, and disseminated pustules on his whole body. On admission, he showed multiple erosions, crusts on the scalp, auricle and wrist joint with swelling around dorsal hands. Laboratory examination revealed hepatorenal function disorder and elevated serum ASO titer and a positive skin culture for group A β-hemolytic streptococcus. We confirmed the dermatological diagnosis as streptococcal impetigo.
Eruption and constitutional symptoms improved immediately with rest and drip infusion of flomoxef sodium, but the swelling around the wrist joint and dorsum of his hand persisted. He did not fulfill the modified Jones criteria for a diagnosis of acute rheumatic fever, and was diagnosed with poststreptococcal reactive arthritis. Treatment with NSAIDs did not provide symptomatic relief; however, prednisone starting at 30 mg/day orally with tapering resulted in complete relief of symptoms.
We report here the first case of poststreptococcal reactive arthritis occurring after severe streptococcal impetigo.
