Keratoderma blennorrhagica is seen in?
Correct Answer: Reactive ahritis
Description: Reactive ahritis REF: Harrison's Principles of Internal Medicine 17' ed-chapter 318 Reactive Ahritis: Associated with HLA-B27 Etiology and Pathogenesis: Of the four Shigella species S. sonnei, S. boydii, S. flexneri, and S. dysenteriae, S. flexneri has most often been implicated. Other bacteria identified definitively as triggers of ReA include several Salmonella spp., Yersinia enterocolitica, pseudotuberculosis, Campylobacter jejuni, and Chlamydia trachomatis. Clinical Features The clinical manifestations of ReA constitute a spectrum that ranges from an isolated, transient monahritis to severe multisystem disease. The joints of the lower extremities, especially the knee, ankle, and subtalar, metatarsophalangeal, and toe interphalangeal joints, are the most common sites of involvement, Dactylitis, or "sausage digit," a diffuse swelling of a solitary finger or toe, is a distinctive feature of ReA. Tendinitis and fasciitis are paicularly characteristic lesions Urogenital lesions: In males: urethritis may be marked or relatively asymptomatic. Prostatitis is also common. In Females: cervicitis or salpingitis Ocular: transient, asymptomatic conjunctivitis, anterior uveitis Mucocutaneous lesions: Oral ulcers, the characteristic skin lesions- keratoderma blenorrhagica, consist of vesicles that become hyperkeratotic, ultimately forming a crust before disappearing. They are most common on the palms and soles, Lesions on the glans penis, termed circinate balanitis, are common Management: Most patients with ReA benefit to some degree from NSAIDs, although acute symptoms are rarely completely ameliorated, and some patients fail to respond at all. Indomethacin, 75-150 mg/d in divided doses, is the initial treatment of choice, but other NSAIDs may be tried. Prompt, appropriate antibiotic treatment of acute chlamydial urethritis or enteric infection may prevent the emergence of ReA. However, several controlled trials have failed to demonstrate any benefit for antibiotic therapy that is initiated after onset of ahritis
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