usmlebuzz
Forum Elite
Topics: 93
Posts: 263
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A 23-year-old man presents
with the acute onset of fever, skin
lesions that are papular and erythematous
with a hemorrhagic and
necrotic center, joint pain, and an
acute tenosynovitis of the dorsum
of his left foot. He has no past medical
history and takes no medications.
He does not smoke, drink
alcohol, or use illicit drugs. On
physical examination, the patient
has a temperature of 102.4°F. Passive
flexion and extension of the
left great toe causes severe pain
over the dorsum of the midfoot and
ankle. Which of the following is the
most likely diagnosis?
a. de Quervain’s tenosynovitis
b. Reiter syndrome
c. Acute gouty attack
d. Disseminated gonococcal infection
e. Still’s disease
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| no more a loser
Forum Guru
Topics: 140
Posts: 580
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i would go with d: dissem gonoccocal infection. 50% r polyarhtritis but tenosynovitis is much more common.
a)de Quervain’s tenosynovitis is seen in hands of females with newborn babies cuz of holding the baby
b)Reiter syndrome: q doesnt mention comjuctivitis
c)younger pt with no hx of alcohol intake
e) Still’s disease: is present is younger pts
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| Drmos
Forum Junior
Topics: 8
Posts: 41
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Hi...a young patient with an acute disease and skin lesions, the first you must rule out is a infectious dz, gonococcal arthritis is the best option. Second, acute gouty attack could be an option but the skin lesions are not common here and there are not risk factors or past medical history.
If we look for skin lesions in reiter´s syndrome, a classic finding is keratoderma blenorrhagica, this is a hyperkeratotic papular rash on the soles of the feet that mimics pustular psoriasis, but these findings are different from the case.
Still dz is not the case here. My option is D.
If I am incorrect or somebody can add more information about skin lesions in these diseases would be great!!!!!!!
Thanks. 
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| Dot
Forum Senior
Topics: 1
Posts: 168
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i will go for acute gout as great toe involvemet is commenest here
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| lucky
Forum Guru
Topics: 23
Posts: 505
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d....
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