People’s Choice: Keratoderma Blennorrhagica; South Asia
Submitted by Kunal Chandwar, MD, MBBS, King George’s Medical University, Lucknow, India, the photo depicts extensive keratoderma blennorrhagica in a patient with reactive arthritis.
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Explore This IssueApril 2022
An 18-year-old man presented with psoriasiform plaque-like lesions that began on the limbs and progressed to involve his entire body (including his face) over a month. He had a painless ulcer near the urethral meatus and glans penis associated with severe debilitating axial and peripheral polyarthritis. He had had unprotected sex and recently developed a urethral discharge.
Given his severe keratoderma blennorrhagica and circinate balanitis and history suggesting a urinary tract infection, a diagnosis of reactive arthritis was made.
Investigations suggested anemia, leukocytosis and thrombocytosis with elevated inflammatory markers. An HIV test was negative; tests for other sexually transmitted diseases and blood cultures were also negative.
The patient received pulse methylprednisolone followed by 0.5 mg/kg of prednisolone, which was tapered rapidly, non-steroidal anti-inflammatory drugs and methotrexate, with doxycycline to treat suspected urethritis, and responded well, with almost complete clearance of skin lesions and improvement in his arthritis.
About the Contest
The Rheumatology Image Library is a highly accessed teaching resource. However, images showing manifestations of rheumatic disease on skin of color are under-represented, creating a significant educational gap. The 2021 Image Competition, held in conjunction with ACR Convergence 2021, encouraged the global rheumatology community to submit images that will help healthcare providers identify rheumatic disease manifestations in skin of color. Here, we depict the image selected as the People’s Choice, from South Asia. In coming issues, we’ll publish the winning images from other regions across the world. The image judged Best Overall appeared in the March issue; the featured image from the East Asia & Pacific region appeared in May.