PMC5389222_01
Multiple crusted plaques over trunk
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F1
Cutaneous examination revealed multiple erythematous dry crusted plaques of variable size and shapes ranging from smallest < 0.5 cm to largest 10 cm x 10 cm over the trunk, distributed mainly over the trunk [Figures 1 and 2], both extremities, both palms and soles (keratoderma blenorrhagicum) [Figure 3], with sparing the scalp, face, and flexures.
Multiple crusted plaques over buttocks
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F2
Cutaneous examination revealed multiple erythematous dry crusted plaques of variable size and shapes ranging from smallest < 0.5 cm to largest 10 cm x 10 cm over the trunk, distributed mainly over the trunk [Figures 1 and 2], both extremities, both palms and soles (keratoderma blenorrhagicum) [Figure 3], with sparing the scalp, face, and flexures.
Keratoderma blenorrhagicum - soles
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F3
Cutaneous examination revealed multiple erythematous dry crusted plaques of variable size and shapes ranging from smallest < 0.5 cm to largest 10 cm x 10 cm over the trunk, distributed mainly over the trunk [Figures 1 and 2], both extremities, both palms and soles (keratoderma blenorrhagicum) [Figure 3], with sparing the scalp, face, and flexures.
Circinate balanitis
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F4
There was single erosion with crusting of 1 cm x 1 cm size over the glans penis [Figure 4] with surrounding erythematous skin and sparing other mucosae.
Histopathology showing marked hyperkeratosis, focal parakeratosis, with spongiosis, irregular rete ridges and few micro abscesses in the epidermis and predominantly lymphocytic infiltrate in perivascular area in the dermis
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F5
Finger nails showing coarse pitting, yellowish discoloration, transverse ridges and subungual hyperkeratosis
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F6
On histopathology of skin biopsy, there were marked hyperkeratosis, focal parakeratosis, spongiosis, irregular elongation of rete ridges, and few microabscesses in the epidermis and predominantly perivascular lymphocytic infiltrate in the dermis [Figure 6].
X-ray hip joint (AP view) showing reduced joint space
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F7
Radiographic study of hip joint revealed reduced joint space and that of spine revealed calcification of the anterior ligament [Figures 7 and 8].
X-ray spine (AP view) showing calcification in spine
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F8
Radiographic study of hip joint revealed reduced joint space and that of spine revealed calcification of the anterior ligament [Figures 7 and 8].