24-year-old man comes to the emergency department due to a few hours of fever with rigors

24-year-old man comes to the emergency department due to a few hours of fever with rigors, headache, and myalgia. While at an urgent care

center last night, he was diagnosed with syphilis and received a dose of intramuscular benzathine penicillin G. The patient has a history of HIV

infection due to unprotected heterosexual intercourse, and a recent CD4 count was 540/mm3. He is not currently taking antiretroviral therapy and

is not on any other medications. He continues to have unprotected heterosexual intercourse with several partners despite counseling. The patient

does not use tobacco, alcohol, or illicit drugs. Temperature is 38 C (100.4 F), blood pressure is 90/60 mm Hg, and pulse is 110/min. The patient is

diaphoretic and appears uncomfortable. A diffuse, faint macular rash involving the palms and soles is present. Genital examination shows a

nontender ulcer with induration and several enlarged inguinal lymph nodes. Which of the following is the most likely cause of this patient’s current

condition?

  • Q A. Anaphylactic reaction to penicillin
  • Q B. Co-infection with Neisseria gonorrhoeae
  • Q C . Disease progression due to resistance
  • Q D. Posttreatment immune reconstitution inflammatory syndrome
  • Q E. Rapid lysis of the spirochetes

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