Suspected Reiters Syndrome

[samworth]

My chum is a long distance lorry driver. In November 2004 he was bitten on his leg by an insect, type unknown. He had an adverse reaction to it however all appeared well relatively quickly. Until some three weeks afterwards when he collapsed. Joint problems, blisters on the backs of his elbows, hands and problems with his feet. The most startling observation was totally red eyes - like a SciFi horror picture. Treated with steriod drops.
He has gone down hill progressively since then, with serious sessions of finding it almost impossible to breath, and at one stage coughed up a large blood clot. Currently he is back in hospital and two striking developments have taken place. One small spots which  quickly enlarge to the size of a finger end first of all these are red, then turn black. Location mainly legs. Plus his breath is horrible, just as though he is rotting from the inside. He was a large healthy guy, had to be for his work. Prior to the lastest changes he had painful joints and
fatigue set in very quick. Whilst Reiter's, septic arithritis
may be a lead. Certainly the turn of events is doing everyone's head in.
Any ideas?  
The medicas are particularly concerned about his breathing at present.  

[samworth]

Wegener's Granulomatosis
See the website for detailed info..
It was in fact.
Chum responded to special treatment
fantastically.
Well on the way to recovery.
WG is one of those rare beasties and
once the diagnosis was correct, the
speed of change was dramatic.
Sam

[samworth]

Yes! He sure is sick.
The indications now are that it is
Wegener's Granulomatosis. A real
******* of a health challenge. You
recall the biopsy on one of the
lesions on his leg.
I'm not a medic, and still recall his
serious reaction to the insect bit last
November. That appeared to clear up
however within weeks he started going
down hill.
Certainly I will look at your suggestion
of Still's - Both the other two possible
complaints are rare anyway.
Thanks for your new thoughts.
Sam

[samworth]

Now having extensive tests in hospital. Apparently
a serious blood immune attack over ten years ago.
Reading up on Reiter's it is a disease from hell.
SamWorth

[MLWTR]

Hi,

It sounds like your friend is very sick. You might want to ask the doctors if they have considered the possibility of adult-onset Still's disease. It is rare, but might possibly match your friend's symptoms. I am putting a link below that has more information. You will have to copy it into the address bar of your browser because I don't know how to insert a hyperlink:

http://www.stillsdisease.org/still's_disease_info.htm

Hope things get better soon.

[Kevin Pho, MD]

Reiter's syndrome typically has the triad of arthritis, uveitis and  urethritis.  I don't think I read any description of urethritis.  You may want to consider an HLA-B27 blood test as well as X-rays for further evaluation.  A rheumatology referral can be considered if Reiter's syndrome is still suspected.  

In regards to the breathing problems, I would consider a pulmonary embolus.  If negative, then a bronchoscopy can be considered to look for masses or cancers in the lung.  I certainly would discuss these options with a pulmonary specialist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b