A 34-year-old man comes to the physician due to painful urination. Physical examination shows a watery penile discharge. Urethral swabs obtained from the patient are negative for gonococcal infection. He is treated appropriately and his symptoms resolve. Two weeks later, he develops acute conjunctivitis, right knee pain, and vesicular rash on his palms and soles. This patient's condition is most likely associated with which of the following?

Question

A 34-year-old man comes to the physician due to painful urination.  Physical examination shows a watery penile discharge.  Urethral swabs obtained from the patient are negative for gonococcal infection.  He is treated appropriately and his symptoms resolve.  Two weeks later, he develops acute conjunctivitis, right knee pain, and vesicular rash on his palms and soles.  This patient's condition is most likely associated with which of the following?

Quizplus · Accepted Answer

11ec160b_3b69_e660_9249_1995ca0587a4_MD0001_00 Urethritis, conjunctivitis, and mono- or oligoarticular arthritis constitute the classic triad of reactive arthritis (ReA). This seronegative (rheumatoid factor-negative) spondyloarthropathy most commonly affects patients age 20-40 and is associated with HLA-B27. Symptoms generally manifest 1-4 weeks following a primary infection causing urethritis or enteritis and are caused by an autoimmune reaction initiated by the infecting pathogen. Skin findings include keratoderma blennorrhagicum (hyperkeratotic vesicles on the palms and soles) and circinate balanitis (serpiginous annular dermatitis of the glans penis). Axial involvement, including sacroiliitis, may occur in about 20% of cases. (Choice A) Esophageal dysmotility is a classic finding in scleroderma although it can occur in other conditions. (Choice B) Hyperparathyroidism may occur in the setting of multiple endocrine neoplasia. (Choice C) Polymyositis may occur in the setting of dermatomyositis or as a separate entity. (Choice E) Tabes dorsalis is a manifestation of tertiary syphilis. Secondary syphilis causes maculopapular or pustular (but not vesicular) rash that can involve the palms and soles; it is generally associated with polyarthritis (mono-arthritis is very rare). Educational objective: The classic triad of reactive arthritis is nongonococcal urethritis, conjunctivitis, and arthritis. It is an HLA-B27-associated arthropathy that occurs within several weeks following a genitourinary or enteric infection. It belongs to the group of seronegative spondyloarthropathies (including ankylosing spondylitis) and can cause sacroiliitis in about 20% of cases.

A 34-Year-Old Man Comes to the Physician Due to Painful