mash
Forum Fanatic
Topics: 147
Posts: 1,326
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A 32-year-old man who was HIV positive presented to a specialist HIV clinic with a one-month history of rectal discharge. Serological tests for syphilis performed five months earlier were unreactive. There were no genitourinary symptoms at this visit. Swabs to test for gonorrhoeal and chlamydial infection were obtained from the throat, urethra and rectum, and the patient was referred for serological tests for syphilis at a follow-up visit one week later (he was immune for hepatitis A and B). He had no penicillin allergy. He was given empirical treatment for chlamydia and gonorrhoea (a single dose of azithromycin 1 g orally and ceftriaxone 250 mg intramuscularly). His contacts were unknown.
Six hours later the patient developed severe fever, chills, rigors, headache, severe myalgia and photophobia and was prostrate in bed overnight. Self-administered paracetamol did not relieve the symptoms, which largely subsided spontaneously after 8 hours.
next day,he noticed a rash on the soles of his feet, and myalgia persisted, but his other systemic symptoms resolved.
wats d diagnosis ?
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| piter
Forum Elite
Topics: 34
Posts: 191
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mjl just posted in previos topic about syphilis
"Jarisch -Herxheimer rxn occurs within a few hours of Rx owing to
increase # of treponemes (fever, HA, INTENSE rash)" - but in real exam such a coincidence, unfortunatly, unreal...
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| mjl1717
Forum Hero
Topics: 958
Posts: 5,465
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Sound like a Jarisch-Herxheimer rxn to me!
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