An 18-Year-Old Man Comes to the Emergency Department Due to 3

An 18-year-old man comes to the emergency department due to 3 days of fever, myalgias, and profound fatigue.  He was feeling fine prior to the onset of symptoms.  The patient has a history of intermittent asthma for which he uses an inhaler as needed.  He is a senior in high school and plays on the football team.  Temperature is 38 C (100.4 F) , blood pressure is 110/80 mm Hg, pulse is 88/min, and respirations are 16/min.  BMI is 22.1 kg/m².  On physical examination, the patient is found to have swollen lymph nodes in his neck and behind his ears.  The tip of the spleen is palpable 1 cm below the left costal margin.  Laboratory results are notable for the following: Which of the following is most likely to be elicited on further history?

A) Anal sexual intercourse
B) Contact with saliva
C) Exposure to urine
D) Prior blood transfusion
E) Recent tick bite
F) School trip to South Asia

Correct Answer:

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