A 48-Year-Old Man Comes to the Emergency Department with Several

question 475

Multiple Choice

A 48-year-old man comes to the emergency department with several days of headache, photophobia, nausea, and vomiting.  He has also had decreased hearing in the left ear and occasional vision floaters for the past week.  The patient has no earache, tinnitus, or vertigo.  He was treated for gonorrhea 6 months ago with a single antibiotic injection.  He uses intravenous drugs and reports having unprotected sex with multiple partners.  The patient does not use tobacco or alcohol and has not traveled recently.  His temperature is 37.2 C (99 F) , blood pressure is 122/68 mm Hg, and pulse is 92/min.  He has bilateral eye irritation and a generalized maculopapular rash, as shown in the exhibit.  Multiple, nontender cervical and inguinal lymph nodes are palpable.  There is sensorineural hearing loss in the left ear and neck stiffness.  Cardiopulmonary examination is normal.  The abdomen is soft and nontender.  The motor examination is symmetric, and reflexes are 2+ bilaterally throughout the upper and lower extremities.  Which of the following is the most likely diagnosis?

• A)Acute retroviral syndrome
• B)Disseminated gonococcemia
• C)Infectious mononucleosis
• D)Meningococcal infection
• E)Secondary syphilis

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