A 35-Year-Old Man Comes to the Office Due to Concern

A 35-year-old man comes to the office due to concern that his HIV medication is no longer working.  Over the last 6 weeks, the patient has had intermittent fevers and awakened several times drenched in sweat.  He has not used injection drugs since he was diagnosed with HIV a year ago, and he lives in a house with other individuals recovering from substance use disorder.  The patient takes antiretroviral therapy and trimethoprim-sulfamethoxazole.  Temperature is 37.9 C (100.2 F) , blood pressure is 126/72 mm Hg, and pulse is 102/min.  Physical examination reveals several enlarged cervical, supraclavicular, and epitrochlear lymph nodes that are rubbery and mobile.  Cardiopulmonary examination is normal, and no organomegaly is present on abdominal examination.  There is no rash.  Chest x-ray reveals an enlarged cardiac silhouette.  Current CD4 count is 208/mm³ and the viral load is undetectable.  Which of the following underlying pathogens is most likely responsible for this patient's symptoms?

A) Bartonella henselae
B) Cytomegalovirus
C) Epstein-Barr virus
D) Hepatitis C virus
E) Human papillomavirus
F) Toxoplasma gondii

Correct Answer:

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