i n d i a n j o u r n a l o f r h e uma t o l o g y 9 ( 2 0 1 4 ) S 7eS 6 7S58

P174. Endocarditis in a rheumatology unit e blurring thedistinction between autoimmunity and infection!

Durga Prasanna Misra, Abhra Chandra Chowdhury,

Sukesh Edavalath, Ramnath Misra, Amita Aggarwal,

Able Lawrence, Vikas Agarwal; Department of Clinical Immunology,Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,India

Introduction: Rheumatic manifestations can be present in greater

than a third of patients with infective endocarditis (IE). These

symptoms can predate the diagnosis of IE by many months.

Methods: We reviewed the diagnoses at discharge in a tertiary

care Rheumatology and Clinical Immunology unit over a period of

1 year (February 2013 to January 2014) for patients with IE.

Results: We identified 6 patients with endocarditis (0.55%) out of a

total of 1089 discharges.

Serial No. Age Sex Presentation Mimicking which rheumatic disease Valve involved Organism isolated

1 63 Female Symmetric inflammatory

polyarthritis

Seronegative rheumatoid arthritis Tricuspid Methicillin-resistant

Staphylococcus aureus

2 27 Female Limb claudication and

absent upper limb pulses

Takayasu's arteritis Mitral Negative

3 34 Male Fever, active urinary sediment,

jejunal artery aneurysm with

high anti-PR3 titres

ANCA-associated vasculitis Mitral Methicillin-sensitive

Staphylococcus aureus

4 25 Female Pulmonary-renal syndrome

following abortion

ANCA-associated vasculitis Tricuspid Negative

5 49 Female Fever, polyarthritis and

bullous skin lesions

Gonococcal arthritis Aortic Escherichia coli and

Pseudomonas

6 31 Male Fever and pancytopenia Systemic lupus erythematosus Aortic Enterococcus

Conclusion: This case series serves to emphasise varied pre-

sentations of endocarditis as mimics of rheumatic diseases, and

highlights the need to be aware of such unusual presentations.

P175. Dual infection with chikungunya and parvovirus B19:Cross-sectional study in northeast India

Sakir Ahmeda, Sanjeeb Kakatia, Lahari Saikiab; aDepartment ofInternal Medicine and bDepartment of Internal Medicine andMicrobiology, Assam Medical College, Dibrugarh, India

Introduction: Interplay between microbes and immunity sculp-

tures autoimmunity. Parvovirus B19 has been implicated in

various autoimmune conditions. Chikungunya is causing a

pandemic of debilitating arthritis, indistinguishable from Rheu-

matoid Arthritis in its chronic form. Literature searches revealed

only 6 cases of chikungunya reported from Northeast India

excluding Meghalaya, and no Parvovirus B19 reported from

Northeast India.

Methods: All consenting patients with acute polyarthritis or an

acute exacerbation of chronic arthritis were enrolled. De-

mographic profile, pattern of joint involvement, functional status

(WHO-HAQDI), disease activity indices and extra-articular mani-

festations were recorded. IgM ELISAs for both Chikungunya and

Parvovirus B19 were performed.

Results: We obtained 49 cases of IgM positive Parvovirus B19, the

first series to be reported from Northeast India. Chikungunya IgM

was positive in 31 cases. 14 cases had dual infection- a phenom-

enon that we have not found reported anywhere worldwide.

Out of total 140 cases, 49 were acute though virus positivity was

equal among acute and chronic cases. The positive cases reported

more of joint erythema though not statistically significant. Three

parvovirus cases had skin rash. No other parameter was different

between virus positive and negative cases. Dual infection did not

significantly alter clinical presentation, arthritis severity or func-

tional status.

Conclusion: Contrary to contemporary beliefs, Chikungunya is

prevalent in Northeast India. Acute parvoviral infection is also

present. Dual infection by these two viruses is being reported for

the first time. The long-term implications of these infections in

Northeast India need further evaluation.

P176. Reactive arthritis: Is it a forerunner ofspondyloarthropathy

Hema M.a, Kavitha M.M.b, Theresa Maryc, S. Balameenab,

Rajeswari S.b; aStanley Medical College, India; bDepartments ofRheumatology and cImmunology, Madras Medical College, India

Aim and Objective: To study the correlation of serum levels of IL

17A and the disease activity of Reactive arthritis and its

outcome.

Methods: Patients who satisfied the “BERLIN” criteria for reactive

arthritis were chosen and followed up. Their disease activity was

assessed at the onset, 6 months and 1 year using DAREA score .CT

sacroiliac joints was taken at the onset and after 1 year .serum

IL17A levels were analysed at the end of 1 year by ELISA.

Results: Among the 46 patients, IL 17A levels were elevated in 22

patients . DAREA score was high in patients with elevated IL17A

levels at the onset, 6 months and the end of 1year. Among IL17A

positive patients 8 developed clinically and radiologically evident

axial spondyloarthropathy and 12 patients developed chronic

reactive arthritis.2 patients went in for remission.

Discussion: IL17A levels were significantly elevated in about

47.8% of our patients of reactive arthritis. Patients who had high

and persistence disease activity had high titres .Even though

IL17A had no statistical significance with spondyloarthropathy