Title : Reactive arthritis following mpox monkey pox vaccination
Abstract:
however ANA, rheumatoid factor Reactive arthritis after various vaccinations has been previously described but such kind of reaction after mpox vaccination has not been previously reported. Here we present a case of recently diagnosed reactive arthritis following intradermal mpox vaccination (JYNNEOS).
Case Report:
A 51-year-old man with a history of HIV on antiretroviral therapy with undetectable viral load, presented with a 2-week history of protracted fever that started few hours after receiving mpox vaccine. He also had severe watery diarrhea and dysuria for a week. Laboratory testing was normal except for elevated acute phase reactants. Cultures, Chest X-ray, and echocardiogram were unremarkable. The diarrhea spontaneously resolved; however, he started having progressively worsening pain and swelling of the left knee and ankle joint. MRI left knee without contrast showed grade 2 tear to the origin of medial collateral ligament with some underlying medial femoral condyle edema and knee effusion. Left knee aspirate yielded 50 cc of clear fluid with slightly elevated WBC count and protein level suggestive of inflammatory arthritis, however ANA, rheumatoid factor and HLAB27 were negative. Joint fluid crystals, cultures and Lyme PCR testing were negative as well. He was started on methylprednisolone for 2 weeks. He subsequently developed migratory arthritis and redness in left eye associated with decreased vision. He was diagnosed with left eye anterior uveitis and treated with prednisone and cyclopentolate eye drops. His symptoms improved while on methylprednisolone, but promptly recurred after completion of steroid course. The patient’s presentation with diarrhea, asymmetrical arthritis, dysuria, and uveitis was felt to be due to reactive arthritis. Given the worsening visual field defect along with migratory arthritis unresponsive to NSAIDs, he was re-started on prednisone 20 mg daily for 1 week followed by 10 mg daily in addition to meloxicam 15mg daily. One month after treatment with steroids and NSAIDs, his arthralgias were well controlled and acute phase reactants returned to baseline, however his visual field defect persistedand HLAB27 were negative. Joint fluid crystals, cultures and Lyme PCR testing were negative as well.
