A 30-year-old previously healthy man presents with a one week history of rash, sore throat, fever, malaise, myalgias, arthragias, and anorexia. He has received all the standard immunizations, including measles and rubeola, and has not to his knowledge been exposed to anyone with a similar illness. He has not traveled outside the USA, and denies animal, animal product, or ectoparasite exposure. His roommate has been symptomatically well. He is not taking any medications. Physical examination reveals a temperature of 101, and a normal pulse, respiratory rate and blood pressure. In addition to the rash (photograph) you find generalized adenopathy, an injected oropharynx, and oral ulcers. Serological tests for EBV and CMV are negative.
DIAGNOSIS: Acute HIV syndrome. About 50-70% of patients develop this syndrome, usually 3-6 weeks after infection. In addition to lethargy & malaise, symptoms can include fever, sore throat, headache, arthralgias, myalgias, anorexia, weight loss, nausea, and vomiting. In addition to rash, generalized adenopathy, oral ulcers, pharyngitis, and neurological abnormalities (meningitis, encephalitis, myelopathy, and/or peripheral neuropathy) may be evident on physical examination. Plasma viral counts are extremely high at this stage of the infection.
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