Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


A 25-year-old healthy man was admitted with a 3-month history of joint pains in his feet and right knee, leading to difficulty ambulating. The patient had been previously treated without a definitive diagnosis, with NSAIDs and systemic steroids, without improvement. He also endorsed a 3-week history of an extensive, diffuse rash with significant involvement of the palms, soles, and genitals. He denied involvement in the oral mucosa or conjunctiva. Lesions were tender—the plantar lesions contributing significantly to painful ambulation. The physical examination was notable for hyperkeratotic scaly purpuric papules and plaques on the soles and between the toes, hyperkeratotic ostraceous nodules on the arms, knees, trunk, and soles, and erythematous scaly plaque on the groin involving the penis. Right fourth finger PIP with swelling. Oral mucosa and conjunctiva were clear; nails were normal. Labs were notable for leukocytosis and elevated inflammatory markers; the urine was positive for chlamydia trachomatis, negative for gonorrhea and HIV, syphilis, ANA, RF was negative while HLA-B27 positive. The diagnosis of reactive arthritis was made and treatment with indomethacin, doxycycline, and prednisone resulted in mild improvement during his hospitalization. This case represents the classic presentation of reactive arthritis with keratoderma blenorrhagicum and balanitis circinata with chlamydia trachomatis infection. Keratoderma blenorrhagicum is characteristic of reactive arthritis, although occurring in only 10% of patients. In patients with palmoplantar keratoderma or otherwise typically appearing psoriasis and psoriatic arthritis, it is important to consider the diagnosis of reactive arthritis and expand the history and physical to elucidate the diagnosis.





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