12-04-2010, 07:30 AM
A 26-year-old man presents with severe bilateral
pain in his hands, ankles, knees, and elbows. He is recovering
from a sore throat and has had recent fevers to
38.9°C. Social history is notable for recent unprotected
receptive oral intercourse with a man ~1 week ago. Physical
examination reveals a well-developed man in moderate
discomfort. He is afebrile. His pharynx is erythematous
with pustular exudates on his tonsils. He has tender anterior
cervical lymphadenopathy. His cardiac examination
is notable for a normal S1 and S2 and a soft ejection murmur.
His lungs are clear. Abdomen is benign with no organomegaly.
He has no rash, and genital examination is
normal. His bilateral proximal interphalangeal joints,
metacarpophalangeal joints, wrists, ankles, and metatarsophalangeal
joints are red, warm, and boggy with tenderness
noted with both passive and active movement. Acomplete metabolic panel and complete blood count are
all within normal limits. His erythrocyte sedimentation
rate is 85 mm/h and C-reactive protein is 11 mg/dL. What
is the most likely diagnosis?
A. Acute HIV infection
B. Acute rheumatic fever
C. Lyme disease
D. Neisseria gonorrhoeae infection
E. Poststreptococcal reactive arthritis
pain in his hands, ankles, knees, and elbows. He is recovering
from a sore throat and has had recent fevers to
38.9°C. Social history is notable for recent unprotected
receptive oral intercourse with a man ~1 week ago. Physical
examination reveals a well-developed man in moderate
discomfort. He is afebrile. His pharynx is erythematous
with pustular exudates on his tonsils. He has tender anterior
cervical lymphadenopathy. His cardiac examination
is notable for a normal S1 and S2 and a soft ejection murmur.
His lungs are clear. Abdomen is benign with no organomegaly.
He has no rash, and genital examination is
normal. His bilateral proximal interphalangeal joints,
metacarpophalangeal joints, wrists, ankles, and metatarsophalangeal
joints are red, warm, and boggy with tenderness
noted with both passive and active movement. Acomplete metabolic panel and complete blood count are
all within normal limits. His erythrocyte sedimentation
rate is 85 mm/h and C-reactive protein is 11 mg/dL. What
is the most likely diagnosis?
A. Acute HIV infection
B. Acute rheumatic fever
C. Lyme disease
D. Neisseria gonorrhoeae infection
E. Poststreptococcal reactive arthritis