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A 29-year-old man presented with concerns about an extensive rash that had developed over the previous month. The rash was reported to involve the scalp, abdomen, penis, hands, and feet (Figures 161-1, 161-2, 161-3, 161-4, 161-5). He also complained of severe joint pain, involving the back, knees, and feet. He denied ocular, GI, or genitourinary complaints, but was prescribed a course of antibiotics last month when his partner was diagnosed with Chlamydia.
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The patient's young age, rapid onset of symptoms, dermatologic findings, and arthritis were suggestive of reactive arthritis. The patient's joint pain was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and skin lesions were treated with topical corticosteroids. No antibiotics were prescribed because no current infectious agent was identified. In conjunction with a dermatologist, acitretin 25 mg daily was started to treat his psoriasiform lesions.
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Reactive arthritis is a noninfectious acute oligoarthritis that occurs ...