A 40 years old man admitted to our ward due to multiple
joint pain and relapsing fever for more than 6 months.
The patient was quite well until 6 months ago he began to
notice pain with swelling over bilateral knee joints, left
ankle joint and fusiform swelling over the 2nd and 3rd digit
of his right hand. 1 month before this admission, he started
to complain lower back pain with morning stiffness. In
addition, hyperkeratotic skin lesions were found over both
hand and feet. Deformed and exfoliated nails were also noted
over toes of both feet. 2 weeks before these episode, he was
suffered from dysuria after an extramarrital sexual
contact.
After admission, physical examination revealed mild
hyperremic conjunctiva, a shollw-based ulcer was found over
his tongue. No lymph nodes were palapble, swelling and local
heat of bilateral knee joints. Tenderness along margin of
sternum and achill tendon.Shallow ulcer was found in his glans
penis but the patient did not ever noticed and no discomfort
was complained at the time of examination.Lung and
cardiovascular system is unremarkable. Erythematous and
hyperkeratotic skin lesions were noted over both palm and sole
with scattered lesion in his lower abdomin.
< Laboratory
data>
Complete blood
count: WBC: 9680/ul,
RBC: 3240000 /ul, Hb: 10.2 g/dl. Platelet:
490000/ul Biochemistry: BUN: 12.7 mg/dl, Cr: 0.92 mg/dl, Na: 138 mmol/l,
K: 4.62 mmol/dl, AST:36u/l ALP: 32 u/l; Uric acid: 9.6 mg/dl
Hematology: ESR: 68/1 hour, Ferritin: 786 ng/ml (normal
range: 17.9 – 464), Iron: 22 ug/dl (51-180), TIBC: 390
(275-332) Immunology: CRP: 24 mg/l (<6.00), RA factor: -,
HLA-B27:+, microbiology: blood culture all
negative
culture.
microbiology:
blood culture all negative culture. Image study: Unilateral sacroilitis, Gr II/IV, right side
L spine: unremarkable finding Both knee joint: soft tissue
swelling.
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