bubble_chart Overview

Postdysenteric Syndrome, also known as Reiter's Syndrome, Postenteric Rheumatoid, or Oculourebroarticular Syndrome, is clinically characterized by conjunctivitis, urethritis, and arthritis. It predominantly affects children, with a higher incidence in males.

bubble_chart Etiology

The cause of the disease is unknown and may be related to infections, including bacterial, viral, and mycoplasma infections. Some cases are systemic complications following dysentery. Some believe it is associated with allergic reactions or endocrine disorders, while others suggest a link to drug allergies, such as penicillin, sulfonamides, or salicylate hypersensitivity.

bubble_chart Clinical Manifestations

The typical clinical manifestations include a triad of conjunctivitis, urethritis, and arthritis, often accompanied by skin lesions. 1. **Conjunctivitis**: The earliest symptom, short-lived, usually bilateral, affecting either the bulbar or palpebral conjunctiva. In severe cases, the entire conjunctiva may be involved, accompanied by conjunctival edema and periorbital swelling. Occasionally, keratitis and iritis may occur. 2. **Urethritis**: Symptoms include urgency, frequency, and dysuria, with possible mucoid discharge. Severe cases may present with hematuria, pyuria, and pain, along with complications such as cystitis and prostatitis, though bacterial cultures of urine show no growth. 3. **Arthritis**: The hallmark symptom, which can affect any joint but predominantly the ankles and knees. It manifests as joint redness, swelling, and pain, often symmetrically, resembling rheumatoid arthritis or ankylosing spondylitis. Severe cases may involve joint effusion and restricted limb movement. 4. **Skin and Mucous Membrane Lesions**: These can involve any part of the body, with the palms, metatarsals, and glans being the most common sites. Typical lesions present as variably sized bullous erythema multiforme. Ruptured blisters lead to erosions and crusting, healing with residual pigmentation that gradually fades. In rare cases, epidermal detachment and confluent erythema may develop on the existing lesions.

In addition to the primary symptoms, systemic toxic manifestations may occur, including fever (up to 39°C), febrile seizures in infants, and absence of shivering. Other symptoms include loss of appetite, nausea, vomiting, diarrhea, restlessness, headache, and dizziness, lasting 2–3 weeks. Severe cases may complicate into pleuritis or endocarditis.

bubble_chart Auxiliary Examination

1. Leukocyte count is often elevated, erythrocyte sedimentation rate is increased, and white blood cells and red blood cells can be seen in the urine, but bacterial culture is negative.

2. X-ray examination may show soft tissue swelling, periarticular thickening, localized osteoporosis, and chronic cases may reveal extensive new bone formation and joint space narrowing.

bubble_chart Diagnosis

The diagnosis of this disease is not difficult based on the triad of conjunctivitis, urethritis, and arthritis, along with typical skin changes.

bubble_chart Treatment Measures

In the treatment of the acute phase, bed rest should be emphasized, along with enhanced care for fetid mouth odor, protection of skin lesion wounds, supplementation of vitamin C, and correction of typical edema electrolyte and acid-base balance. Adrenal corticosteroids are the preferred medication, initially administered intravenously and then switched to oral maintenance once symptoms improve. Antipyretic and analgesic drugs, such as aspirin and indomethacin, may also be used. Broad-spectrum antibiotics should be applied to prevent and treat infections. For chronic synovitis, synovectomy may be performed, and joint fusion can be considered if joint destruction occurs. A small number of cases may resolve spontaneously, with reported mortality rates ranging from 5% to 15%.

bubble_chart Differentiation

Differentiate from rheumatoid arthritis and ankylosing spondylitis.