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Correspondence to Dr Kiyoshi Shikino; kshikino@gmail.com
Description
A healthy man in his 30s presented with a 3-month history of fever and malaise. He reported high fever and generalised rash 3 months ago, and also reported similar symptoms 1 week ago. The patient was sexually active with men only; he had a new sexual partner from 4 months ago. Medical history is significant for atopic dermatitis. He had no medications and allergies. On physical examination, body temperature was 37.5℃, blood pressure was 122/62 mm Hg, pulse rate was 104/min and respiration rate was 16/min. A generalised rash including palm and sole was noted (figure 1). Enlarged non-tender lymph nodes presented in the left cervical and both inguinal regions. On laboratory tests, white bood cell (WBC) was 15 200/μL (24.0% neutrophils, 68.0% lymphocytes, 4.0% atypical lymphocytes), C-reactive protein was 0.39 mg/dL, aspartate aminotransferase (AST) was 165 U/L, alanine aminotransferase (ALT) was 264 U/L, lactate dehydrogenase (LDH) was 497 U/L, alkaline phosphatase (ALP) was 1661 U/L and γ-glutamyl transpeptidase (γ-GTP) was 321 U/L. Subsequent results of laboratory revealed positive treponema pallidum antibody haemagglutination test, rapid...