Description
A 26-year-old woman, previously healthy, that a month ago started complaining of pain in the soles of both feet, which followed, additionally, to the right knee, the left knee, left elbow and right shoulder. She reported morning stiffness exceeding 1 hour that decreased with physical activity, worsened with rest, but improved with administration of non-steroidal anti-inflammatory drugs (NSAIDs). Three weeks later, skin lesions appeared on the soles of the feet.
Seven to 8 weeks before, the patient would have had two successive episodes of a urinary tract infection, treated, respectively, with fosfomycin and ciprofloxacin. The patient did not present gastrointestinal symptoms, previous weight loss or sweating.
On physical exam , it was verified pain at knee mobilisation, more intense in the left, where it presented articular effusion.
The cutaneous lesions were about 0.5 cm in diameter, were maculopapular, on a background of diffuse erythema and of desquamation on large blades (
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