WBR0708

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Allergy/Immunology, Infectious Disease
Prompt	30 years old white male come to clinic for new hire routine check-up. He has no significant complain. He admits having multiple sexual partners, not using condoms frequently. He didn’t have HIV test before. His past medical history is insignificant. He doesn’t smoke but drink alcohol regularly. He has no drug or food allergy. His physical examination is insignificant. You ordered HIV and RPR test which turned to be positive. His CD4 is 300 mm3 and RPR titer 1:70. The diagnosis of HIV infected patient with latent syphilis of unknown duration was established. The patient begins his treatment with benzathin penicillin G IM weekly for three weeks. Several hours later, the patient presents to ED with severe headache, muscle pain, fever and rigors. Which of the following could have prevented this condition?
Answer A	Careful allergic history taking
Answer A Explanation	Incorrect Jarich-Herxheimer reaction is not an allergic reaction
Answer B	Detailed family history
Answer B Explanation	Incorrect Jarich-Herxheimer reaction is not an inherited drug allergy
Answer C	Nothing could prevent this condition
Answer C Explanation	Correct No effective prevention is available, the patient should be informed with this possible condition, and advised to contact his clinician in severe cases
Answer D	Pre-treatment with antihistamines
Answer D Explanation	Incorrect Antihistamines has no role in immunological acute febrile reaction
Answer E	Assessment of drug sensitivity more accurately
Answer E Explanation	Acute febrile reaction is not a sensitivity rather than immunological reaction
Right Answer	C
Explanation	Jarich-Herxheimer reaction is an acute febrile reaction develops within 24hours after the initiation of any syphilis treatment. Fever is usually accompanied with headache, malaise, chills, and myalgias. The etiology is not clear. No effective prevention is available. The patient should be informed with this possible condition, and advised to contact his clinician in severe cases. Educational Objective: References:
Approved	No
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