The Great Imitator: Presenting in Urgent Care

Given the presence of the following palmar rash and the likely diagnosis what is the name of the anal skin lesions that are commonly associated with this specific diagnosis?

Fig. 1 via CDC PHIL

When screening the patient for other symptoms they deny any neurological, cardiac or ocular symptoms. What additional screening/examination should be performed or organised before discharging the patient?c

The patient is referred to local sexual health screening services for further testing and it was decided to begin empirical treatment for potential neurosyphilis. They are then brought back to resus following a suspected allergic reaction. The patient was treated with antibiotics 30 minutes ago and quickly began to panic and fell to the floor. The patient began convulsing and an ambulance was called. On review in resus the patient is now calm and asymptomatic. They did not receive any benzodiazepines, the convulsive episode appears to have been self-limiting.

What was the likely cause of the patients symptoms?