A traveler returning from South Africa with rash and genital ulceration.

Abstract

A 35-year-old white man presented with a 5-day history of malaise, headache, fever, and regional lymphadenopathy with severe asthenia. Three weeks previously, he had traveled to South Africa for 1 week, where he was a participant in an adventure race in the rural Transvaal region. On examination, we found a genital ulceration (figure 1) and painless inguinal adenopathy, and a maculopapular rash (figure 2). The WBC count was 5400 cells/mm3 with 3870 neutrophils. The C-reactive protein level was 38 mg/L (normal value, <3 mg/L). Results of liver function tests were slightly elevated, with an alanine aminotransferase level of 105 U/L (normal value, <65 U/L), an aspartate aminotransferase level of 65 U/L (normal value, <45 U/L), a lactate dehydrogenase level of 531 U/L (normal value, <390 U/L), an alkaline phosphatase level of 94 U/L (normal value, <109 U/L), and a y-glutamyltranspeptidase level of 147 U/L (normal value, <70 U/L). Blood cultures were sterile. The results of serological tests for syphilis and HIV ELISA with p24 antigen assay were negative.