1268 Letters to the editor

and mechanisms of action. AmJI Med 1970; 48: field group G streptococci. A left wrist aspirate Group G streptococci have been associated 443-8. 4 Markand 0 N, D'Agostino A N. Ukrastructural showed no organisms on Gram staining, and with previous reports of septic arthritis,' but Ann Rheum Dis: first published as 10.1136/ard.51.11.1268 on 1 November 1992. Downloaded from changes in skeletal muscle induced by col- no subsequent growth even after enrichment the low virulence confines most serious disease chicine. Arch Neurol 1971; 24: 72-82. culture. Five sets of blood cultures were to patients with a predisposition to infection.2 5 Riggs J E, Schochet S S, Gutmann L, Crosby sterile. Antistreptolysin 0 titre was >1000 are T W, DiBartolomeo A. Chronic human There case reports of sterile reactive colchicine neuropathy and myopathy. Arch international units (IU) per millilitre (normal arthritis in septicaemic patients.' 3 In this Neurol 1986; 43: 521-3. <200). White cell count was 17 5xl09/l patient there was no evidence of septicaemia, 6 Kuncl R W, Duncan G, Watson D, Alderon K, (neutrophils 14-9), haemoglobin 143 g/l, plate- joint aspiration of the wrist showed no growth, Ropwski M A, Peper M. Cokhicine msyopathy lets 327 x l09/l, erythrocyte sedimentation rate and he had been previously well. His subse- and neuropathy. N Engl J Mod 1987; 316: 1562-8. 75 mm/h, C reactive protein 375 mg/l (normal quent arthritis and enthesitis was flitting and 7 Kuncl RW, Duncan G. Chronic human coichicine <100), normal biochemistry except for alkaline short lasting, which is much more characteris- myopathy and neuropathy. Arch Nuol 1988; phosphatase 412 IU/I (normal 80-280), y- 45: 245-6. tic of reactive and rheumatic fever arthritis4 8 Kuncl R W, Cornblath D R, Avila 0, Duncan G. glutamyltransferase 82 IU/I (normal 10-48), than of multifocal sepsis, though the distribu- Elektrodiagnosis of human colchicine myo- ferritin 839 tg/l (normal 10-385). Rheumatoid tion of joint and enthesis involvement was neuropathy. Muscle Nerve 1989; 12: 360-4. factor, antinuclear antibodies, and anti- unusual. Furthermore, bacteraemia rarely 9 Lazaro R P, Kirshner H S. Proximal muscle weakness in uremia. Arch Neurol 1980; 37: neutrophil cytoplasmic antibodies were nega- complicates pharyngitis.5 Host antibody 555-8. tive. The following were normal or negative: responses are poor in streptococcus group G 10 Lin H, Rocher L L, McQuillan M A, Schmaltz S, left wrist and chest radiographs; urine analysis pharyngitis, so that until now no cases of post- Palella T D, Fox I H. Cyclosporine-induced and mid-stream urine culture; electrocardio- streptococcal sequelae have been described in hyperuricemia and gout. N EnglJ7 Med 1989; 321: 287-92. gram; echocardiogram; viral antibody screen; group G pharyngitis.' As far as we are aware hepatitis B serology; yersinia, brucella, and this represents the first reported case of borrelia antibodies. HLA class I typing was reactive arthropathy complicating such an Al B8 B15. infection in the absence of septicaemia. It Reactive arthritis and group He was admitted to hospital. Treatment was appears therefore that group G streptococcal continued with ampicillin and indomethacin infection may be yet another cause of reactive G streptococcal pharyngitis 50 mg three times daily. Over the next 10 days arthritis and enthesitis. he experienced prolonged morning stiffness L YOUNG Sir: A previously healthy 29 year old man and a swinging fever. The neck pain and C M DEIGHTON presented to his general practitioner with a capsulitis of the right shoulder rapidly settled. A J CHUCK week long history of fever, sore throat, and There was sequential painful involvement of Department of Rheumatology Dryburn Hospital polyarthralgia. A throat swab was taken and the left wrist, both supraspinatus tendons, left Durham DHI 5TW treatment was started with ampicillin 250 mg then right hip, right wrist, and bilateral United Kingdom and ibuprofen 600 mg, both four times daily. adductor enthesitis, with each episode lasting He was seen two days later with more 24-72 hours. The erythrocyte sedimentation A GALLOWAY Departmnt of Microbiology profound malaise, and a synovitic left wrist, rate peaked at 128 mm/h four days after Dryburn Hospital and was referred to us. There was no history admission, and the platelets at 859x 109/l nine Durham DHI 5TW of rash, dysuria, bowel disturbaace, or eye days later, returning gradually to normal United Kingdom symptoms. He had a stable heterosexual thereafter. The C reactive protein slowly fell Correspondence to: Dr Deighton. relationship. On examination his temperature to normal. Indomethacin was discontinued was 390°C, with generalised tender cervical when a mild hepatitic picture developed on lymphadenopathy and an inflamed throat. the liver function tests, and prednisolone 40 1 Gaunt P N, Seal D V. Group G streptococcal infection of joints and joint prosthesis. J Infect There was synovitis in the left wrist and mg daily was introduced. Thereafter, no new 1986; 13: 115-23. restricted movement. Neck movement was joint or enthesopathic symptoms developed, 2 Gaunt P N, Seal D V. Group G streptococcal globally restricted, with evidence of capsulitis and results of liver function tests were normal. infections. J Infect 1987; 15: 5-20. 3 Rogerson S J, Beeching N J. Reactive arthritis of the right shoulder and supraspinatus He was discharged 16 days after admission. complicatinggroupGstreptococcalsepticaemia. tendonitis in the left. The results of the rest of Within two months all inflammation had J Infect 1990; 20: 155-8. http://ard.bmj.com/ the examination were entirely normal. subsided with a full return to normal function 4 Homer C, Shulman S T. Clinical aspects of rheumatic fever. J Rheumatol 1991; 18 (suppl The throat swab (taken by the general of all joints. The prednisolone has been 24): 2-13. practitioner before starting treatment with tapered rapidly, and the patient has returned 5 Barnham M. Bacteraemia in streptococcal antibiotics) showed a heavy growth of Lance- to full time employment. infections of the throat. J Infect 1983; 7: 203-9. on September 26, 2021 by guest. Protected copyright.