well: 1st photo: the Oroya fever or Carriòn disease, a bartonellosis (by bartonella bacilliformis) 2nd photo: circinate balanitis--> Reiter's disease 3rd photo: keratoderma blenorrhagica --> Reiter's disease 4th photo: It seems like a stevens Johnson syndrome So, if I'm not wrong: the patient is taken ill with the Oroya Fever, that has, among its complications, the possible overwhelming by some bacteria, including Salmonella. So the patient develops a salmonellosis, but unfortunately he is predisposed to develop also a Reactive Arthritis (caused by salmonella enteritidis and other bacteria), the so called Reiter's syndrome,that, besides the classic triad arthritis-urethritis-uveitis, can show itself also with balanitis circinata and keratoderma blenorrhagicum (showed in the photos). At last, the patient undergoes also a Stevens Johnson Syndrome, maybe due to the drugs he took: in fact, both antibiotics for salmonellosis, for instance trimethoprim+sulfamethoxazole or a quinolone (and ciprofloxacin is used also for the bartonellosis!) and anti-inflammatory drugs for Reiter's arthritis could lead to a SJS. bad luck: sometimes it's worse than you can imagine.
