Differential diagnosis
This patient’s symptoms included pelvic inflammatory disease, conjunctivitis, mucositis, and arthralgias. Diagnoses that would tie these signs and symptoms together include disseminated gonococcemia, chlamydial infections, Reiter’s syndrome, and Stevens Johnson syndrome.
Lab tests: White blood cell count, chlamydia and other STDs
Her complete blood count revealed leukocytosis with a white blood cell count of 17,000 and a left shift of 6% bands. Endocervical DNA probe was positive for Chlamydia trachomatis. Blood cultures were negative.
Because many sexually transmitted diseases occur concurrently or are transmitted together, the patient was also tested for HIV, syphilis, and hepatitis B and C. The patient gave her consent for the HIV test, which came back negative. Serologies for syphilis and hepatitis B and C were drawn and found to be negative. A test for the human leukocyte antigen HLA-B27 was ordered because of the concern that this was Reiter’s syndrome; the test result was negative.
Diagnosis: Reiter’s syndrome
This patient was diagnosed with Reiter’s syndrome, based on her clinical syndromenjunctivitis, arthralgias, mucositis, and cervicitis. The widespread distribution of the symptoms in this syndrome may be due to activation of the immune system by a viral or bacterial agent.6,7
The fact that her HLA-B27 test result was negative did not change this diagnosis; only 85% of patients with the syndrome are positive for HLA-B27, and the test results are frequently negative in African Americans.4,5