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AIR: WHAT: Gonococcal skin lesions. Gonococcal Skin Lesions: hemorrhagic or vesicopustular skin lesions characteristically seen in disseminated gonococcal infections. WHY: The presence of gonococcal skin lesions in a patient with arthritis is highly suggestive of gonococcal arthritis. HOW: Two types of mature skin lesions are consistently seen in gonococcal bacteremia. One is a hemorrhagic (purpuric) papule. The other is a vesicopustular lesion on an erythematous base. Both lesions begin as pinpoint erythematous macules, and typically appear during the first day of symptoms in association with a febrile episode. The purpuric lesions do not blanch with local pressure and often are found on the palms and the soles. They last about a week gradually fading from a dark blue color to a dark brown and then a light brownish yellow color. The vesicopustular lesions evolve through papular, vesicular and pustular stages reaching a maximum diameter of about 2.5 cm. All these stages may be present at the same time. The ma
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