A 35-year-old man with HIV was being followed in
an outpatient internal medicine clinic. At a routine visit,
screening laboratories were checked. The clinic never contacted the
patient about his laboratory test results, and he assumed they were
normal. He returned to his normal lifestyle, including occasional
unprotected sexual activity.
One month later, he developed a rash. The
outpatient clinic was unable to see him immediately, and
recommended he go to the urgent care clinic. The urgent care
provider reviewed his lab results and discovered that his tests for
rapid plasma reagin (RPR) and Treponema antibody were both
positive. Examination was notable for a classic syphilitic rash
(Figure),
confirming the diagnosis of secondary syphilis. The patient was
treated with penicillin in the urgent care clinic. However, he
subsequently developed a Jarisch-Herxheimer
reaction and was admitted to the hospital.
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