PHEOCHROMOCYTOMA RELATED CARDIOMYOPATHY. Papules that progress to hemorrhagic pustules develop on the trunk and extensor surfaces of the distal extremities. Asymmetric joint involvement of the knees, elbows, wrists, MCPs and ankles occurs. The cutaneous and articular findings are due to an immune reaction to circulating gonococci and to immune-complex deposition. Synovial fluid cultures are consistently negative and blood cultures are positive in less than 45% of patients. If cultures are negative, alleviation of symptoms in 12 to 24 hours after antibiotic therapy supports a clinical diagnosis. Initial treatment is IV ceftriaxone. A similar arthritis-dermatitis syndrome may occur with N. meningitides. If cultures are negative, this must be considered in the differential. However, gonococcemia and meningococcemia respond to similar antibiotic treatment.