American Medical Student Association

A 38-year-old male with rash

The case below is followed by a choice of diagnoses. Select the one lettered selection that best describes the patient’s condition.

A 38-year-old male presents with a two-week history of low grade fevers, headaches, sore throat, fatigue, muscle aches, poor appetite, swollen lymph nodes and rash. He saw a doctor and was told he probably had a viral infection. He was instructed to rest and drink plenty of fluids. In the past week, his symptoms have persisted, and he noted worsening of the rash and weight loss. He states that the rash initially was faint and patchy, involving primarily his upper chest and his forearms, and had a pale red appearance. In the last week, though, he has noticed that the rash spread all over his body. The rash is not itchy or painful. He does not recall any sick contacts or unusual exposures, although he is sexually active with a history of multiple partners in the past, and he had a new sexual partner approximately three months ago. On physical examination, his temperature is 100.2 F, blood pressure is normal, pulse 100/ min. His throat appears red, with no exudates or oral lesions. He has diffusely enlarged lymph nodes, including the cervical, axillary and inguinal regions. He has mild right upper quadrant tenderness on abdominal examination. Skin examination is notable for a symmetric, diffuse, dull red papular rash involving his trunk and extremities, including his palms and soles. The remainder of his examination is unremarkable, including a normal genital examination. Laboratory data are notable for AST 65 u/L, ALT 88 u/L, alkaline phosphatase 288 u/L, with a normal bilirubin, WBC 11,300/L, hemoglobin 12.4 g/dL, platelets 598,000/uL.

What is the clinical diagnosis of this patient’s condition and its underlying pathophysiology?

A. Infectious mononucleosis

B. Influenza

C. Secondary syphilis

D. Lyme disease