Abstract In this report we describe the cases of two siblings with
reactive arthritis (ReA) induced by pharyngeal
infections. The patients were a man and his sister living with their parents. He developed
arthritis in August 1997, and his younger sister developed similar symptoms in September 1998. Their disease conditions were both severe and required hospitalization. Their conditions improved with the administration of nonsteroidal anti-inflammatory drugs together with
antibiotics, and both fully recovered within 1-2 weeks.
Rheumatic fever was ruled out since
streptococcal infections were not demonstrated with
antistreptolysin O (ASO) or
antistreptokinase (ASK) titers, or with pharyngeal culture. The sister suffered from a
rash which was similar to
erythema nodosum on her lower extremities, but neither
chorea nor
carditis was observed. Both
human leukocyte antigen (HLA) typing analyses revealed positive results for
HLA-B40 and -B39 for the brother and sister, respectively. Both
HLA-B40 and -B39 are considered to be related to HLA-B27-negative ReA, most likely poststreptococcal
reactive arthritis (PSRA). Therefore, the two patients were tentatively diagnosed as suffering from PSRA.