A 42 year-old African American female came to the emergency room complaining of fever, chills, and generalized pain in her joints, abdomen, and pelvis. Her symptoms began gradually over the previous 48 to 72 hours. She reported she had not been sexually active in the previous 3 weeks, and had no abnormal vaginal discharge, pharyngitis, or eye pain. She had only taken occasional acetamino-phen and denied illicit drug use.
The physical exam revealed a temperature of 102.6°F orally but otherwise normal vital signs. Bilateral nonpurulent conjunctival infection (Figure 1) and oral mucosal inflammation (Figure 2) were plainly evident. Neck, chest, and cardiovascular examinations yielded no abnormal findings; however, her abdomen was diffusely ten-der without distension or organomegaly.
Pelvic exam revealed normal mucosa with thin white cervical discharge and cervical motion tenderness. Exam of the extremities showed no joint effusions or induration, but arthralgia was noted in both of her elbows, knees, and wrists. She had no rashes.
FIGURE 1
Conjunctivitis
FIGURE 2
Oral inflammation
What is the differential diagnosis?
What additional tests should be performed?
What is the initial treatment?