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NBME3 (joint pain) - hope08
#1
20. A 47-year-old woman comes to the physician because of a 2-day history of fever and joint pain. Six days ago, she completed a 10-day course of dicloxacillin for folliculitis. She appears comfortable. Her temperature is 38.6°C (101.5°F), pulse is 72/min and regular, respirations are 16/min, and blood pressure is 120/76 mm Hg. Examination shows an urticarial rash over the trunk and extremities. There is moderate generalized lymphadenopathy and diffuse joint tenderness. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these symptoms?

A
) Epstein-Barr virus infection

B
) IgE-mediated allergic reaction

C
) Mycobacterium haemophilum infection

D
) Serum sickness

E
) Staphylococcal sepsis
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#2
dd??
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#3
agree
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#4
Definitely D
Reasons:
Took more than 5 days to appear.
characterised by
fever rash arthralgia lymphadenopathy
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#5
why not AA
ebv>>infectious mononucleoisis,LNs,fever,
plus treating the pt of IMN with dicloxacillin >>gives generalized rash
i am not sure,but need further reading
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#6
That is Ampicillin life_saver00; not Dicloxacillin.

I agree with Option D. This is type III hypersensitivity reaction; formation of Ag-Ab complexes. Can we discuss on what caused antigenemia in this case?
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