“I think I am allergic to something.”
History of Present Illness
JS is a 27-year-old man who presents to a free health clinic at the county hospital. He states he was in his usual state of health until about 3 days ago when he began developing a rash on his stomach that is now on the palms of his hands and soles of his feet. The rash is not painful or itchy. He states that he had this strange little “ulcer-like” thing on his penis a couple weeks ago but it went away and never really hurt. He is single and sexually active with two to three concurrent male partners. He has had unprotected sex with “at least one of his partners” in the past couple of weeks. He doesn’t know the sexual histories of his current or past sexual partners, and admits to over 15 lifetime partners. He endorses rectal and oral sex. He doesn’t ever recall being tested for HIV, and knows he received all his childhood vaccines, “cause my mom told me.” He has never been vaccinated against HPV stating, “that’s a woman’s disease,” and is unsure if he ever has received a hepatitis A vaccine.
Father had HTN and passed away from a stroke 4 years ago; mother is still living and has type 2 DM
MSM with multiple sexual partners; (+) EtOH, (–) Tobacco, (+) Marijuana, (–) Illicit drugs
Ibuprofen 200 mg PO PRN pain (has taken 4 doses in the last day)
Temp 101°F, P 72, RR 16 breaths per minute, BP 141/85 mm Hg, pO2 94%, Ht 5′7″, Wt 60 kg
NAD, awake, alert, slightly underweight man
Diffuse mucocutaneous rash noted on abdomen, back, upper extremities (including palms of hands) and soles of feet; macules are easy to blanch and are not associated with any area of fluctuance
PERRLA; EOMI; mucous membranes are moist and neck is supple without any evidence of lymphadenopathy
Clear auscultation with no wheezing or rhonci
NTND with no rebounding or guarding; (+) BS; noted rash ...