REITERS SYNDROME - A CASE REPORT

Abstract : Reiters syndrome , a form of reactive arthritis is characterized by a triad of arthritis, non-gonococcal urethritis, conjunctivitis and psoriasiform cutaneous and mucosal lesions.It usually occurs following an an intestinal or genito urinary tract infection. A 35 yr old male presented with widespread raised lesions of six months duration and joint pain of 2 months duration. The patient gave a history of unprotected sexual contact with an unknown female 7 months back. He also had a history of recurrent dysuria suggestive of urethral inflammation, which subsided spontaneously. The patient also gave a history of redness of both the eyes and discharge from both the eyes 3 months back. Dermatological examination revealed multiple well circumscribed erythematous scaly plaques of varying sizes present all over the body and palmo plantar keratoderma (keratoderma blennorrhagicum) . Finger and toe nails showed onyhodystrophy and subungual hyperkeratosis. Skin biopsy revealed hyperkeratosis, parakeratosis, neutrophilic microabscesses, regular acanthosis, and dermal inflammatory infiltrate. Urine culture showed growth for Proteus vulgaris. HLA B27 was positive in the patient. The patient was treated with Methotrexate and the cutaneous lesions resolved in 7 weeks. This case is presented for the classical cutaneous manifestations and the rapid response to systemic Methotrexate. Keyword :Reiters syndrome, HLA B 27, Keratoderma blennorrhagicum