Reiter's Syndrome as a Manifestation of an Immune Reconstitution Syndrome in an HIV-Infected Patient: Successful Treatment with Doxycycline

SIR—Although Reiter's syndrome is noted in up to 10% of HIV-infected patients with arthritis 1, complete remission of this syndrome after receipt of antibiotic therapy has rarely been reported. We examined a 25-year-old homosexual man who was admitted to the hospital with chills and fever (temperature, ≥40°C) and who was passing bloody and mucous stool. In addition, he referred to having intermittent diarrhea during the 2 years before presentation. Four days before hospital admission, painful swelling of his thumb joints and ankles started. Clinical examination revealed tender knee joints with effusion, hemorrhagic conjunctivitis, and typical papular-erythematous balanitis circinata. HIV infection had been diagnosed in 1998, with a virus load of 150,000 copies/mL and a CD4 cell count of 400 cells/μL. He began receiving antiretroviral therapy after diagnosis, and HAART (consisting of didanosine, stavudine, and nevirapine), with which the patient was fully compliant, had been started 6 months before presentation. As a consequence, his CD4 cell count increased to 723 cells/μL, and his HIV-1 RNA level decreased to >50 copies/mL.