An unusual pattern of arthritis dermatitis syndrome

A 27-year-old woman presented with skin lesions and arthritis of the right knee of 2 days' duration. Her medical history was noncontributory and synovial fluid aspirated from the affected knee and a biopsy of a skin lesion were negative for gonococci. However, after methylene blue staining of cervical and urethral smears, intracellular and extracellular diplococci were demonstrated. Immunofluorescence showed deposits of immunoglobulin complexes of the skin section within the wall of blood vessels and dermal-epidermal junction. Treatment with ampicillin, 4 gm a day, resulted in resolution of the lesions and arthritis in 2 days. The need for cervical and urethral smears and for better, as yet unavailable tools for the diagnosis of the arthritis dermatitis syndrome, is emphasized.