A 30-year-old male presented with pain and swelling of the knee and the ankle joint of the right side especially at the inseion sites along with burning and pain sensation during micturition, urethral discharge, fever for 2 weeks. Patient also gave a history of multiple episodes of bloody diarrhea 1 week back. O/E. B/L conjunctivitis with oral ulcers Plantar fasciitis Onycholysis and distal yellow discoloration of nails X- ray pelvis with B/L hip was normal. Lab findings revealed raised ESR and other acute phase reactants along with mild anemia and increased HLA B27 titers. Joint aspirate was sterile.

This is a case of reactive ahritis (Reiter syndrome) following a GIT infection. This can be easily remembered by mneumonic CAN'T SEE, CAN'T PEE , CAN'T CLIMB A TREE. This is not septic ahritis as the joint aspirate was sterile. This is not psoriatic ahritis as it firstly it is a chronic process and no characteristic skin lesions were there. This is not ankylosing spondylitis as there was no sacroiliatis. 1ST image shows keratoderma blennorrhagicum- hyperkeratotic vesicles and pustules forming a crust especially on soles of feet. 2ND image shows circinate balanitis which are vesicles on glans penis which rupture to form superficial erosions. 3RD image shows dactylitis of 1st metatarsophalangeal joint giving the characteristic sausage shaped digit.