A 27-year-old male had burning micturition and urethral discharge. After 4 weeks he developed joint pains involving the knees and ankles, redness of the eye and skin lesion. The most probable clinical diagnosis is:
Ans. is 'b' i.e., Reiter's syndrome Occurrence of Arthritis and conjunctivitis following urinary tract infection suggests the diagnosis of Reiter's syndrome.Reiter's syndrome refers to the triad ofReactive arthritisConjunctivitisUrethritisBut this term has fallen out of favour particularly following recent revelations of Reiter's involvement in war crimes during World War II. Now the term Reactive arthritis is used to describe this condition.Features of Reactive arthritisAsymmetric, oligo articular inflammatory arthritis of lower extremities.Arthritis most commonly affects the knees and the ankles. cultures of synovium and synovial fluid are sterile therefore the term reactive arthritis.Enthesitis (plantar fascia inserts onto the inferior aspect of calcaneus, this produces heel pain)Dactylitis (usually in the form of sausage toes).Associated with antecedent genitourinary and gastro- intestinal infections. Genitourinary infections with chlamydia trachomatis and gastrointestinal infections with shigella, salmonella and yersinia species is common.Axial skeleton involvement characterized by unilateral sacroiliitis. This is seen in 20% cases.Extraarticular involvement which includes -Conjunctivitis Anterior uveitis Oral ulcer Circulate balanitisKeratoderma blennorrhagicum (papulosquamous rash of soles and palms)Laboratory diagnosis -Mild anemiaModest LeucocytosisModerate to marked thrombocytosisElevated E.S.R.* Also know * Criteria for the diagnosis of Bechet's diseaseClinical featureDefinitionRecurrent oral ulcerationMinor aphthous, major aphthous or herpetiform ulcerations observed by physical or patient that recurred at least three times over a 12 month period.Plus two of the following criteria'sRecurrent genital ulcerationAphthous ulceration or scarring observed by patient or physician.Ocular lesionsAnterior uveitis, posterior uveitis or cells in vitreous on slit lamp examination, or retinal vasculitis observed by ophthalmologistSkin lesions
Psoriasis vulgaris
Reiter's syndrome
Behcet's syndrome
Sarcoidosis
S.T.D.