Circinate balanitis in HLA B27 spondyloarthrithis: A report of two cases

Circinate balanitis is a characteristic mucocutaneous lesion commonly associated with reactive arthritis (ReA), previously described as Reiter's disease. It typically presents alongside other ReA symptoms, including urethritis, conjunctivitis, and arthritis, but can occasionally occur as an isolated finding. We report two cases of circinate balanitis occurring in patients with HLA B27-positive spondyloarthritis, without the classical triad of reactive arthritis. A 32-year-old male presented with recurrent erosions on the glans penis for 2 years, with a history of HLA B27-positive spondyloarthritis. He was on treatment with tofacitinib, deflazacort, and sulfasalazine. A skin biopsy from the scrotum confirmed the diagnosis of psoriasis. MRI spine and sacrum showed anterior syndesmophyte formation and right-sided sacroillitis. The final diagnosis was circinate balanitis in association with HLA B27-positive psoriatic spondyloarthritis. A 41-year-old male presented with recurrent erosions on the glans penis for 4 years with history of HLA B27 positivity, and ankylosing spondyloarthritis. The biopsy from the glans penis showed squamous hyperplasia. MRI spine and pelvis was suggestive of inflammatory spondyloarthropathy of the cervical, dorsal and lumbar spine with bilateral sacroilitis. The final diagnosis was circinate balanitis with primary ankylosing spondylitis. Both cases highlight the diagnostic challenge of distinguishing between different forms of spondyloarthritis in the presence ofcircinate balanitis.