QuestionSBA
QuestionChoice
The combination of flu-like symptoms, lymphadenopathy, a macular rash, and potential IV drug use/homelessness raise concerns for HIV seroconversion illness. This affects up to 80% of people who newly acquire the virus. HIV testing should be carried out. If negative, this should be repeated, in case infection has taken place inside the window period.
10028286
a
HIV infection
QuestionChoice
This describes a phenomenon that occurs within 24 hours of antibiotic treatment in spirochete infections, e.g. syphilis, leptospirosis, and Lyme disease. There is no clinical history to indicate the patient has been treated for such an infection, and the presentation is incompatible with this reaction.
10028289
d
Jarisch Herxheimer reaction
QuestionChoice
Tertiary syphilis presents with significant neurological and cardiovascular complications. This would not explain the symptoms the patient is experiencing. Secondary syphilis (which causes a widespread maculopapular rash) could be a differential, and should be tested for, along with HIV.
10028288
c
Tertiary syphilis
QuestionChoice
EBV infection is a differential given the widespread lymphadenopathy, fevers, and rash. However, symptomatic EBV usually affects the teenage population. The risk factors mean that HIV seroconversion illness is the diagnosis that is most important to investigate for.
10028290
e
Epstein Barr virus infection
QuestionChoice
Primary syphilis presents with a painless ulcer (a chancre), usually on the genitals. This would not explain the symptoms the patient is experiencing. Secondary syphilis (which causes a widespread maculopapular rash) could be a differential, and should be tested for, along with HIV.
10028287
b
Primary syphilis
QuestionComment
Could this be EBV associated lymphoma- hodgkins or burkitt's?
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Intravenous Sclerosis
Concept
Chapter
2693
4541
Primary HIV infection
Topic
194
Infectious Diseases
18055
Consider HIV infection in patients presenting with flu-like symptoms, lymphadenopathy, and a macular rash, especially in high-risk populations.
A 48-year-old man has had flu-like symptoms for the past week. He visits his GP as he has noticed multiple swellings around his neck and in both armpits. He also reports a low-grade fever.

On examination, the patient appears to have a widespread macular rash. He also has scars in both antecubital fossae.

He has not visited a doctor for 20 years and is currently homeless.

What is the most important diagnosis to consider?
a