Question

A 20 YO heterosexual male presents for evaluation of a rash that he thinks is an allergic reaction. For the past 4 or 5 days he has had the “flu,” with fever, chills, headache, and body aches (myalgia). He has been taking an OTC flu medication without any symptomatic relief. Yesterday, he developed a diffuse rash of red, slightly raised bumps that cover his whole body. He states that the rash must be an allergic reaction to the flu medication.

NKDA - He has no known history of allergies and takes no other medications.

PMHx - Significant for treated gonorrhea ~ 2 years ago. He admits to “occasionally” having sex with men (MSM).

He denies any dysuria, penile discharge, or current genital lesions. However, he states that he had a ‘sore” on his penis a few months ago that never really hurt and went away on its own after a few weeks.

PE = VSS - WNL (Vital signs stable – Within Normal Limits)

Skin – erythematous, maculopapular eruption covering his whole body, including his palmar and plantar (soles of feet) surfaces. No vesicles are noted.

Lymph nodes - +++palpable cervical, axillary, and inguinal adenopathy

Genital (GU) – exam WNL (no discharge)

1. What organism is the likely etiology of this disease?

2. What disease and stage does this patient have?

3. What microscopic examination could confirm this diagnosis?

4. Which serologic tests could assist in his diagnosis?

Answer 1

Answer:

• 1): Bacteria- Treponema pallidum
• 2): person is suffering from syphilis.
• since rashes appeared on the palmar soles,this suggests the patient is in secondary stage of syphilis.
• 3) : Darkfield microscopy, wavy in shape.
• 4) : Both treponemal and non- treponemal test.
• Non-treponemal test includes - Venereal Disease Reasearch Laboratory (VDRL), Rapid Plasma Reagin Test (RPR) and Automated Reagin Test (ART)
• Treponemal test- Treponema Hemagglutination Inhibition test (TPHI).

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