Clinical tetrad of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions (HLA-B27-associated spondyloarthropathy, Reiter syndrome): report of a case.

Abstract	A 21-year-old male patient with the clinical tetrad of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions, commonly known as Reiter syndrome was presented. He was hospitalized in poor condition, with fever, bilateral conjunctivitis, swollen and painful knee and tarsal joints, low back pain, Achilles tendonitis, dactilitis, keratoderma blenorrhagica, purulent urethritis, circinate balanitis, and oral erosive lesions. Radiography and Computerized Axial Tomography (CAT) showed sacroileitis, spondilosis thoracalis, and arthritis of the feet. The laboratory studies revealed anemia, neutrophilic leukocytosis, elevated erythrocyte sedimentation rate (ESR), hypoalbuminemia, negative rheumatoid factor, pyuria, proteinuria, and the presence of HLA-B27. The microbiological examinations of samples from pustular lesions, throat, eyes, urethra, stool, and blood were sterile. Urethral smear was positive for Chlamydia trachomatis (PCR). The histopathological picture of skin lesions was consistent with pustular psoriasis. Systemic treatment with antibiotics, corticosteroids, and non-steroidal anti-inflammatory drugs produced clinical improvement. This clinical syndrome requires comprehensive evaluation and multidisciplinary management.
Authors	K Chudomirova, Ts Abadjieva, R Yankova
Journal	Dermatology online journal (Dermatol Online J) Vol. 14 Issue 12 Pg. 4 (Dec 15 2008) ISSN: 1087-2108 [Electronic] United States
PMID	19265617 (Publication Type: Case Reports, Journal Article)
Chemical References	Anti-Bacterial Agents Anti-Inflammatory Agents, Non-Steroidal HLA-B27 Antigen Steroids
Topics	Anti-Bacterial Agents (therapeutic use) Anti-Inflammatory Agents, Non-Steroidal (therapeutic use) Arthritis, Reactive (diagnosis, drug therapy, immunology) Chlamydia Infections Conjunctivitis (diagnosis, immunology) Drug Therapy, Combination HLA-B27 Antigen (blood) Humans Male Mouth Diseases (diagnosis, immunology) Mouth Mucosa Psoriasis (diagnosis, immunology) Radiography Steroids (therapeutic use) Tomography, X-Ray Computed Urethritis (diagnosis, immunology, microbiology) Young Adult

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