Recurrent rash and orogenital ulcers

A woman in her 30s presented with a one year history of a recurrent rash on her hands in association with oral and genital ulcers. She was otherwise well and took no regular medication but described recurrent episodes of dysuria and frequency, followed 1-3 days later by the development of oral and genital ulcers and painful dermal plaques. She had been treated several times during these episodes for presumed recurrent urinary tract infections but received no other treatment and the rash had resolved spontaneously after a few weeks. No systemic symptoms such as fever or arthralgias were experienced.

Examination during an acute episode showed dusky pink targetoid plaques on the palms (fig 1). Similar lesions surrounded the genital skin and two superficial ulcers were present on the labia minora. She had no oral lesions. Blood test results were unremarkable. A swab from a vulval …