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Young Man With Joint Swelling Sees a Spot

At a followup visit, this 36-year-old man being treated for reactive arthritis mentions seeing a dark spot in his field of vision. What does this tell you?

The patient, a 36-year-old man, presented two months ago with swelling of the ankles and wrists. The examination and results were unremarkable except for an elevated CRP of 2.57 mg/dL and a mild prominence of the left hilum on a chest radiograph.

His rheumatologist diagnosed acute reactive arthritis, and initiated oral prednisone.

Now he remarks that he has noticed a dark spot in the field of vision of his left eye, which over six days has come to look more like a line.

What does this tell you about his diagnosis?

Click here for the full case study and discussion.