Keratosis Blennorrhagica

Abstract

joint, as previously reported by Shands.11 This author, in studying the synovial fluid from ten Charcot joints, found streptococci in two knees and Staphylococcus aureus in one shoulder. In our series of six joints on which operations were performed, culture of material obtained at operation from one knee yielded a mixture of hemolytic streptococcus and Staphylococcus aureus.In this case the operative wound suppurated and the joint failed to fuse. This experience indicates the importance of obtaining a bactériologie study of the synovial fluid before operating on a Charcot joint.SUMMARY AND CONCLUSIONS 1. The diagnosis of a neuro-arthropathy rests on the observation of a swollen, relaxed and disorganized joint which is comparatively painless, in a case present-3LUCGI1K »UPlLi PUPILLARY REFLEXES TO LIGHT }' DEEP REFLEXES KNEE JERKS In 3< ANKLE JERKS I* ' Fig. 7.-Reflexes of tabetic arthropathies.ing the clinical signs of tabes dorsalis, syringomyelia or other involvement of the spinal cord.2. A series of forty cases presenting sixty-five tabetic arthropathies was tabulated according to sex incidence, the age at which symptoms in the joint began, the occur¬ rence of acute trauma as an initiating factor, the dis-BLOOD WASSERMANN ]> li H ++ +++ ++++ j> SPINAL FLUID WASSERMANN MENINGE AL COLD CHLORIDE CURVE D* ; Fig. 8.-Serologie reaction of tabetic arthropathies. tribution of involvement of the joints, and the sérologie and reflex features.3. The positive clinical evidence of rigid pupils and absent knee jerks is of much greater importance in the diagnosis of a tabetic arthropathy than are the various tests which are performed on the blood and spinal fluid. 4. A culture of the synovial fluid should be made prior to any operative procedure on a Charcot joint.In 1893 Vidal1 described a generalized symmetrical eruption involving the nails in a patient with gonorrheal polyarthritis. In 1912 Simpson 2 described the first case occurring in the United States. Keim 3 in 1924 observed and recorded a similar case in which he made minute microscopic studies and reviewed all the pertinent literature, analyzing the disease from an etiologic angle and differentiating it from pustular psoriasis.Since 1924 there have been numerous additions to our knowledge of this syndrome, particularly concerning its response to treatment. Our purpose is to review briefly the more recent literature and to record studies made on two patients who have been under our care at Bellevue Hospital. ETIOLOGYThe genesis of keratosis blennorrhagica has been discussed by G\l=e' \nner and Boas,4 Scomazzoni,5 Rostenberg and Silver 6 and Ormsby in the discussion of a paper by Ebert and Slepyan,7 the consensus being that the cutaneous reaction is an allergic expression of a sensitized skin, similar to the conception of the tuberculid reaction. Chauffard and Fiessinger8 interpret the lesions as a manifestation of gonococcic septicemia in the presence of a severe arthropathy, although the find¬ ing of the gonococcus in the lesions has been infrequent. Barrett,9 Wa...

Arthritis associated with Venereal Disease : A Comparative Study of Gonococcal Arthritis and Reiter's Syndrome

“…Circinate balanitis, a typical feature, according to Ford (1958), was found in seven patients. Keratodermia blennorrhagica, ascribed to gonorrhoea by Combes, Dietrich, and Cohen (1940) and Gateley (1945), was found only in patients with Reiter's syndrome. Rare manifestations, such as neurological lesions (Csonka, 1958a, b;Oates and Hancock, 1959) and cardiac involvement (Csonka and Oates, 1957;Csonka, Litchfield, Oates, and Willcox, 1961), were not observed among these patients.…”