Picture Quiz - Answers

Answers

(1) Further information required includes the patient's full sexual and travel histories. You also need to establish the presence or absence of urethral orgastrointestinal symptoms.

(2) The rashisapunctate, pustular, hyperkeratotic eruption on the soles of both of his feet. This is consistent with either pustular psoriasis or keratodermable norrhagica.

(3) Reiter's syndrome. This is defined as the triad of inflammation of the genital tract (urethritis and balanitis), conjunctivitis, and arthritis. Reiter's syndrome is an example of a reactive arthritis. A reactive arthritis is a non-septic arthritis that is probably triggered by a micro-organism interacting with a predisposing genetic background. Genitourinary pathogens such as Chlamydia trachomatis and Ureaplasma urealyticum and gut pathogens such as Shigella dysenteriae, Salmonella typhimurium, Yersinia enterocolica, and Campylobacter jejuni have been implicated.

Kirsty Rogerson, senior house officer, Royal Liverpool University Hospital, Liverpool


studentBMJ 2000;08:45-88 March ISSN 0966-6494