ABSTRACT
A 35-year-old man with ankylosing spondylitis who is recovering from a diarrheal illness complains of blurred vision, arthritis, and the lesions shown here. What is the diagnosis?
a. Circinate balanitis of Reiter’s syndrome b. Erythroplasia of Queyrat c. Syphilis d. Lichen planus e. Zoon’s balanitis
• Classic Reiter’s syndrome consists of arthritis, conjunctivitis (30%), and urethritis (45%). Reactive arthritis is the hallmark, other associations being less common
• Other commonly reported associations are circinate balanitis (25%-70% of males), uveitis (12%-20%), oral lesions (14%), nail changes (13%), and keratoderma blennorrhagicum (i.e., a papulosquamous skin eruption most commonly on the palms and soles, 23%)
• The penile lesions of circinate balanitis in the setting of arthritis are virtually diagnostic of Reiter’s syndrome
• Nongonococcal urethritis is the most common infection associated with Reiter’s syndrome (46%). Enteritis also may be associated
• Chlamydia trachomatis can be isolated from up to 70% of men who show signs of urethral infection. However, the skin lesions of circinate balanitis do not appear infected
• The penile lesions are usually painless
• There is a strong association with HLA-B27 (75%)
• Most noninfectious symptoms resolve within 3 to 12 months and can be treated conservatively with nonsteroidal antiinflammatory drugs. There is a recurrence in about 15% of patients, and chronic arthritis develops in about 15% of patients
