Virginia Research Day 2022

Medical Resident Research Case Reports

05 Preventing Neurologic Complications Of Syphilis In Elderly Patients With Multiple Comorbidities

Bushra Ferdous, DO; Amber Stephens, DO Corresponding author: Bushra.Ferdous@LPNT.net

SOVAH Health Family Medicine Residency

Context: Elderly Patients with history of undiagnosed syphilis may suffer from serious complications like neurosyphilis as they fail to get initial treatments with antibiotics. Currently, many facilities are not reporting the diagnosis of syphilis in elderly population. Case Report: A 61-year-old African American female who previously had an intracranial hemorrhage in 2020, and TIA, admitted to the hospital for respiratory distress secondary to COVID-19 infection and confusion. Medical History: Intracranial hemorrhage 2020, TIA, IDDM type 2, seizure disorder, essential hypertension, hyperlipidemia, ESRD dialysis on Tuesday, Thursday, Saturday, cervical disc bulging, chronic bronchitis, recurrent C diff, ambulatory dysfunction, wheelchair bound. Family History (Hx): Mother: Deceased, ovarian cancer, diabetes, hypertension. Father: Deceased, diabetes, heart disease, hypertension, hyperlipidemia.

Social Hx: Former smoker, quit approximately 5 years ago.

of nonspecific ascites, mild bilateral lower lobe lung opacities edema versus infection, bladder wall thickening with gas in the bladder, cardiomegaly, arterial and aortic atherosclerotic calcifications. Head CT did not show any acute abnormality, atrophy, positive for chronic microvascular disease. Diagnosis: Acute metabolic encephalopathy secondary to neurosyphilis. Treatment: RPR 1:1 titer and tPA-PA was reactive. Infectious Disease recommended to place patient on penicillin G for 14 days. Patient was continued on penicillin G 4,000,000 units IV every 4 hours for 14 days. Patient was advised to follow up every 6 months for repeat RPR for 2 consecutive years per CDC guidelines. Comment: Studies have shown that the diagnosis of syphilis in elderly patients is significantly delayed due to their multiple underlying comorbidities. A thorough evaluation should be complicated for altered mental status in elderly patients despite their past medical history to ensure that every patient receive treatment in a timely manner.

Pertinent Review of Systems: Positive for some diarrhea, but no vomiting, shortness of breath at times, confusion. Pertinent Physical Exam: Temp 98.1, Blood pressure 210/95, pulse 77, respiratory rate 22, required 93% on room air frail, chronically ill-appearing, alert, verbal, and cooperative, in no acute distress. Normal respiratory effort on 2 L nasal cannula. Alert and oriented to person only, slow speech, could follow simple commands and move all extremities without any trouble. Pertinent Lab: WBC 3.1, hemoglobin 12, hematocrit 41. Sodium 142, potassium 4.5, chloride 100, bicarb 20, BUN 78, creatinine 11, glucose 106. ECG: Normal sinus rhythm, prolonged QTC, nonspecific T-wave abnormalities without any significant ST elevation or depression. CT abdomen and pelvis showed small amount

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