MRCP2-2771

MRCP2-2771

A 20-year-old male presents to the general medical take with large grey lesions around his perineum and in his mouth which started 2 days ago. He reports that he has a more general rash on his trunk and the palms and soles of his feet. He generally feels unwell with malaise and fever. He has never had anything like this before but mentions that he did see a small ulcer on his scrotum a month ago that didn’t hurt and healed on its own. What is the most likely diagnosis?

On examination, he has a symmetrical, widespread, maculopapular rash on his trunk, limbs and the palms and soles of his feet. This is different from the large greyish lesions that you see in his mouth and perineum. He has general lymphadenopathy that is minimally tender on palpation. His chest is clear on auscultation, there are no added heart sounds and his abdomen is soft and non-tender. Investigations show: Haemoglobin 13g/dl, WCC 11 x 10^9/l, Platelets 352 x 10^9/l, CRP 89 mg/L, Sodium 145 mmol/l, Potassium 3.8 mmol/l, Urea 4 mmol/l, Creatinine 82 µmol/l.