Fever and Rash in a Young Man

Dr. Lisa Thomas: Today’s case is that of a 30-year-old man who presented to the Emergency Department (ED) complaining of 3 days of fever and 1 day of a new rash. The patient was in his usual state of health until 4 days before ED presentation, when he developed diffuse myalgias and severe exhaustion followed by sore throat, neck pain, and subjective fevers. On the morning of presentation, his temperature was 40.6 C (105 F) orally and he also noted the onset of a new erythematous, macular rash that began on his upper chest and spread quickly over his torso, face, arms, and legs. The rash was not itchy or painful. He was worried about the high fever and new rash and so he presented to the ED. The patient had no significant past medical history and he was fully immunized. His only medications were acetaminophen 650 mg and ibuprofen 800 mg as needed for fever and myalgias over the past 3 days. There were no known drug allergies. The social history revealed no tobacco, alcohol, or drug use. The patient lived alone and was recently single after breaking up with his only male sexual partner 2 weeks previously. He had no history of sexually transmitted diseases (STDs) and had no newpartners since the breakup. He had also had negative human immunodeficiency virus (HIV)/STD testing 2 weeks prior. The patient had worked as a spiritual educator but had become unemployed 6weeks prior. Hewas volunteering at a church and actively seeking employment. The patient denied new products, pets, recent travel, significant outdoor exposures, or tick bites. The family history was non-contributory.