Abstract
A 47-year-old man who has sex with men (MSM) with a history of chronic hepatitis B virus (HBV) presented with fever and a diffuse non-pruritic rash involving his trunk and extremities, including palms and soles. On examination, he had tender inguinal lymphadenopathy but no hepatosplenomegaly or jaundice. His liver enzymes were elevated from his baseline: aspartate aminotransferase 524 U/L, alanine aminotransferase 510 U/L, alkaline phosphatase 278 U/L, and total bilirubin 1.4 mg/dL. An acute flare of HBV was considered initially; however, it was believed to be less likely when serology testing returned negative for HBV core antibody immunoglobulin M.
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