A 52-Year-Old Man Comes to the Physician for Intermittent Sore

question 97

Multiple Choice

A 52-year-old man comes to the physician for intermittent sore throat, nocturnal high fevers, cold sweats, fatigue, anorexia, and weight loss over the last 4 weeks.  He also complains of pain and swelling of his hands and wrists and brief episodes of a rash.  He does not recall any tick bites and has no travel history or ill contacts.  His temperature is 39 C (102.2 F) , blood pressure is 100/70 mm Hg, and pulse is 92/min.  Oropharyngeal mucosa is dry without exudates.  There are several enlarged cervical lymph nodes.  A scarce macular, nontender, purple rash is noted on both arms.  There are no heart murmurs.  Splenomegaly is noted.  Synovitis is present in several joints including both hands, wrists, and elbows.  A moderate effusion is present in the left knee joint.  Laboratory results are as follows:

Which of the following is the most likely diagnosis?

• A)Adult-onset Still's disease
• B)Felty syndrome
• C)Meningococcemia
• D)Post-streptococcal reactive arthritis
• E)Sweet syndrome

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