There are also scattered white round and annular papules on the labia minora and vestibule

Introduction Found in female Reiter syndrome, Reiter syndrome is characterized by aseptic urethritis, conjunctivitis and multiple arthritis. It can be found in skin and mucous membranes and other organ lesions. It often has fever before onset, which is more common in adult males. .

Cause

The etiology and pathogenesis of Reiter syndrome are still unclear, and can be summarized as the following hypotheses:

1. Infection theory

Reiter was suspected to be an infectious disease caused by spirochetes, as the case was first reported by Reiter in the blood. Most of the people suffering from the symptoms are young males, and often have urinary tract infection symptoms and unclean sexual intercourse or history of treatment, so it is suspected that the intrinsic is related to gonorrhea and fourth sexually transmitted diseases. As mentioned earlier, the intrinsic may be secondary to non-bacterial urethritis or dysentery caused by various pathogens.

2. Genetics and immunology

Because the intrinsic patients have increased ESR, C-reactive protein is positive, IgG, IgA and 2 globulin are increased, and aseptic synovitis can occur after non-bacterial urethritis or enteritis, suggesting that immune factors have a certain pathogenesis. effect. However, it has not been confirmed that the intrinsic body fluid or cellular immune abnormalities are as common as systemic lupus erythematosus. Intrinsic arthritis may not be caused by antibodies or T cell-mediated responses.

an examination

Related inspection

Vaginal secretions check urethral secretion examination

Female Reiter syndrome is rare, and female genital skin and mucosal rash are less common. Edwards (1992) reported a female patient who started fingertip redness, tenderness, and nail separation, and had vaginal secretions, mucosal damage, and underarm pustules, and cultured with Candida albicans. After 4 years, vaginal discharge appeared, accompanied by painless oral ulcers, followed by red scarring plaques in the female genitals and perineum. After MTX treatment, the skin lesions gradually subsided, but after the reduction, the skin rash recurred, and the female genital skin showed pink scaly papules with a diameter of 1 to 2 mm. The boundary was clear. The labia minora and vestibule also had scattered white round and annular papules. The diameter is about 2 to 4 mm. The entire external reproduction can be seen with clear spatial boundaries and apical erosive papules. Skin and labia minora biopsy is consistent with Reiter's syndrome.

Auxiliary inspection:

1, the peripheral blood white blood cell count is often increased, generally (10 ~ 18) × 109 / L (10 000 ~ 18 000 / mm3), individual can exceed 20 × 109 / L (20 000 / mm3), there are a few cases of white blood cells The count does not increase; those with longer duration may have anemia; in most cases, the erythrocyte sedimentation rate increases.

2, urethral secretions contain a large number of white blood cells, mostly polynuclear white blood cells, often pyuria, also visible hematuria.

3, synovial fluid opacity, some cases showed obvious purulent, white blood cell count is often (2 ~ 5) × 109 / L (2000 ~ 5000 / mm3), even up to 10 ~ × 109 / L, most of the early In multinucleated white blood cells, the proportion of inflammatory reaction subsides decreases, but it becomes lymphocyte-based, and the sugar content in synovial fluid is normal. However, when the number of white blood cells is particularly high, the sugar content can be reduced, and the synovial complement level is usually dominated by bar cells. The sugar content in the liquid is normal, but the sugar content can be reduced when the number of white blood cells is particularly high. The synovial complement level is usually higher than other exudates, the protein content is increased, and the protein complement binding rate is similar to joint degeneration, rheumatism and rheumatoid arthritis. .

4, urethra, prostate secretion gonococcus culture negative, no blood and serum found in the bacteria, conjunctival exudate sterile or only non-pathogenic bacteria.

5. Most of the leukocyte histocompatibility antigen HLA-B27 is positive.

Differential diagnosis

1, rheumatoid arthritis: its arthritis performance and even X-ray findings are similar to the intrinsic, so Cecil has included Reiter syndrome in the clinical abnormalities of rheumatoid arthritis. However, general rheumatoid arthritis does not occur at the same time as urethra, conjunctivitis and skin and mucous membrane damage.

2, ankylosing spondylitis: patients with intrinsic chronic spinal disease must be differentiated from ankylosing spondylitis, there is no significant difference between the two eyes and X-ray findings, but if there is a history of periarthritis with urethritis, especially Reiter syndrome is supported by purulent catarrhal keratosis.

3, gonorrhea arthritis: gonococcal arthritis is limited to the synovial membrane, does not invade the joint, joint culture of gonococcal culture is negative, but the urethral purulent secretion culture is positive, but the intrinsic can not find gonorrhea. Although there are annular balanitis in the intrinsic, the foreskin balanitis and urethral redness and swelling of different gonorrhea, intrinsic skin damage and pyloric keratosis are characteristic of gonorrhea, and gonorrhea is characterized by vascular pustular skin disease.

4, pustular psoriasis: pustular psoriasis and Reiter syndrome of purulent keratosis, both clinical and histological are very similar, such as psoriasis involving the conjunctiva, then more The volume is confused, but psoriasis has no history of urethritis and dysentery.

5, Behce syndrome: Reiter syndrome has urethritis and arthritis, while Behcet's syndrome is not. Intrinsic oral and genital damage is erosion and scarring after blister rupture, while Behcet's disease is a deeper ulcer. Intrinsic seldom occurs in women, while the latter is more common in women. Intrinsic is rare in China, and Behcet's disease is not uncommon.

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