'Can’t see, can’t pee, can’t climb a tree'

What does this old saying indicate about this patient?
question mark

A 31-year-old female presents to the ED with a two-day history of pain on urination and discomfort in her left knee and heel.

She also complains of right eye pain, which is exacerbated by reading and bright lights.

She has recently recovered from a gastrointestinal illness — two weeks earlier — but is otherwise healthy.

Examination reveals a swollen left knee that is warm to the touch and tenderness at the insertion point of the left Achilles tendon.

Her right eye is red, and she has direct and consensual photophobia. Cells and flare are noted in the right anterior chamber on slit-lamp examination.

Based on this patient’s probable diagnosis, which of the following cutaneous manifestations is most likely? 

  • Hyperkeratotic lesions
  • Evanescent erythema
  • Bulls-eye rash
  • Purpuric papules 

Check your answer under the image.

Image credit: @millymoo.

Answer: Hyperkeratotic lesions

This patient exhibits several features of reactive arthritis, a form of spondyloarthritis that arises following an enteric or genitourinary infection caused by specific pathogens.

Patients typically present with an asymmetric oligoarthritis and accompanying genitourinary and ocular symptoms.

Keratoderma blennorrhagica, hyperkeratotic skin lesions on the soles and palms, is a characteristic cutaneous finding associated with the condition.

You can see more images like this on Figure1.